Efficacy analysis of percutaneous vertebroplasty in the treatment of upper thoracic vertebral metastases of advanced-stage tumors

English Keywords:Vertebral metastases  Thoracic vertebrae  Vertebroplasty

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy and safety of percutaneous vertebroplasty(PVP) in the treatment of upper thoracic spine(T1-T4) metastases in patients with advanced-stage tumors. Methods: Data were collected from patients with advanced-stage upper thoracic spine metastases who underwent PVP at the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, from October 2012 to February 2019. A retrospective analysis was conducted on 45 patients(62 vertebrae) with complete follow-up data. Among them, there were 19 males and 26 females, aged 43-88 years(64.2±13.5 years). The affected vertebrae included 4 T1 vertebrae, 7 T2 vertebrae, 23 T3 vertebrae, and 28 T4 vertebrae. All the patients were in the advanced stage of cancer(Tokuhashi revised score ≤8 or Tomita score ≥7), presented with severe back pain, without spinal cord compression. The operation related parameters, bone cement leakage, and complications were collected. Preoperative and postoperative(3d, 3 months, and 6 months) visual analogue scale(VAS) scores, analgesic usage scores, and Karnofsky performance scores(KPS) were collected to comprehensively evaluate improvements in postoperative quality of life. Results: All patients successfully completed the PVP procedure. The operation time ranged from 25 to 85mins (45.1±13.3mins), intraoperative blood loss ranged from 5 to 30mL(12.8±6.6mL), and bone cement injection volume per vertebra ranged from 1.5 to 5mL(2.8±0.7mL). Cement leakage occurred in 21 vertebrae of 17 patients, with a leakage rate of 33.87%(21/62). No severe complications were observed. Preoperative VAS score was 7.9±1.1, postoperative 3d score was 3.8±1.5 points, postoperative 3 months was 2.9±0.8 points, and postoperative 6 months was 3.0±1.3 points. The preoperative analgesic usage score was 3.3±0.8 points, the postoperative 3d score was 1.7±0.8 points, the postoperative 3-month score was 2.8±0.9 points, and the postoperative 6-month score was 1.4±0.9 points. VAS and analgesic usage scores at all postoperative time points showed significant improvement compared to preoperative scores(P<0.05). Preoperative KPS score was 52.7±10.1 points, postoperative 3d score was 62.6±8.2 points, postoperative 3 months was 64.9±8.9 points, and postoperative 6 months was 59.1±17.0 points. There was a significant increase in postoperative 3d and 3 months′ KPS scores compared to preoperative value(P<0.001), while there was no significant difference in postoperative 6 months′s score compared to preoperative value(P=0.135). Conclusions: For patients with advanced-stage upper thoracic spine metastases and limited life expectancy, PVP effectively alleviates back pain and significantly improves early postoperative quality of life. However, the relatively high rate of cement leakage warrants attention.