Percutaneous Vertebral Augmentation Assisted
by PEEK Implant in Painful Osteolytic Vertebral
Metastasis Involving the Vertebral Wall:
Experience on 40 Patients

Background: Vertebral metastases are associated with significant pain, disability, and morbidity. Open surgery for fracture stabilization is often inappropriate in this cancer population due to a poor risk-benefit profile, particularly if life expectancy is short. Vertebroplasty and kyphoplasty are appealing adjunctive procedures in patients with malignancy for alleviation of intractable pain. However, these patients have a higher risk of serious complications, notably cement extravasation. Study Design: We prospectively evaluated clinical results of polyetheretherketone (PEEK) implant (Kiva) assisted vertebroplasty performed in malignant painful osteolytic lesions at risk for cement extravasation due to vertebral wall involvement. Setting: Department of Interventional Radiology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy Methods: Forty patients (22 women; mean age 66.8 ± 12.4), suffering from a painful spine malignancy with vertebral wall involvement not responding to conventional therapies and without surgical indications, underwent vertebral augmentation with Kiva intravertebral implant for pain palliation. The procedure was performed with moderate sedation and local anesthesia under combined digital fluoroscopy and computed tomography guidance. After the coil-shaped PEEK implant was deployed within the vertebral lesion, bone cement was injected under continuous digital fluoroscopic control. Patients were discharged from the hospital the next procedural day. The Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), analgesic requirement, and use of external brace support were evaluated to determine efficacy. The primary end-point was safety and efficacy at one month after the procedure. However, all the patients were scheduled to be followed-up at month 3, 6, and every 6 months thereafter. Follow-up was prospectively evaluated in all patients after Kiva with clinical interviews. The Institution’s Internal Review Board approved this study. Results: Median pre-treatment VAS of 10 (range 6 – 10) significantly (P < 0.001) dropped to one (range 0 – 3), with all patients achieving a clinically relevant benefit on pain at one month. Differences in pre- and post-treatment analgesic therapy were significant (P < 0.001). All patients no longer use an external brace after Kiva. In 7 out of 43 (16.3%) treated vertebrae a bone cement leakage was detected. Limitations: This is a not randomized study. Participants were limited to 40 patients. Conclusion: The Kiva System potentially represents a novel and effective minimally invasive treatment option for patients suffering from severe pain due to osteolytic vertebral metastases. Key words: Vertebroplasty, metastases, pain palliation, Kiva, spine

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A case of multilevel percutaneous vertebroplasty for vertebral metastases resulting in temporary paraparesis

Journal of International Medical Research ◽

10.1177/0300060519835084 ◽

2019 ◽

Vol 48 (2) ◽

pp. 030006051983508

Author(s):

Guan Shi ◽

Fei Feng ◽

Chen Hao ◽

Jia Pu ◽

Bao Li ◽

...

Keyword(s):

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Spinal Nerve ◽

Vertebral Compression Fractures ◽

Vertebral Metastases ◽

Osteoporotic Vertebral Compression Fractures ◽

Invasive Treatment ◽

Compression Fractures ◽

Cord Injury

Percutaneous vertebroplasty (PVP) is a minimally invasive treatment that has been widely used for the treatment of osteoporotic vertebral compression fractures and vertebral tumors. However, the maximum number of vertebral segments treated in a single PVP remains controversial. Furthermore, PVP may cause complications, including cement leakage, pulmonary embolism, bone cement toxicity, and spinal nerve-puncture injury. We report the rare case of a patient who underwent multilevel PVP for vertebral metastases, with no bone cement leakage or spinal cord injury, but who developed temporary paraparesis.

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Biomembrane formation after radiofrequency ablation prevents bone cement extravasation during percutaneous vertebroplasty for treating vertebral metastases with posterior margin destruction: An animal study

Journal of Cancer Research and Therapeutics ◽

10.4103/jcrt.jcrt_177_20 ◽

2020 ◽

Vol 16 (5) ◽

pp. 1082

Author(s):

Yongzheng Wang ◽

Zhe Yu ◽

Shilin Tian ◽

Wei Wang ◽

Yuliang Li

Keyword(s):

Radiofrequency Ablation ◽

Bone Cement ◽

Animal Study ◽

Posterior Margin ◽

Percutaneous Vertebroplasty ◽

Vertebral Metastases ◽

Cement Extravasation

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Percutaneous tissue debulking and cement augmentation for advanced malignant vertebral compression fractures

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.9535 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 9535-9535

Author(s):

B. Georgy ◽

W. Wong

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Vertebral Compression Fractures ◽

Intractable Pain ◽

Compression Fractures ◽

Complication Risk ◽

Relieve Pain ◽

Cortical Defect ◽

Cement Extravasation ◽

Oncologic Treatment

9535 Background: Percutaneous cement injection procedures (eg vertebroplasty, kyphoplasty) are used successfully to palliate patients with painful osteoporotic vertebral compression fractures (VCFs). When VCFs occur because of malignant lesions however, treatment can be challenging; often by the time symptoms occur, the tumor has extended into the epidural tissue and is associated with posterior cortical disruption. As a result, patients have a higher likelihood of cement extravasation outside the vertebral body, thought to be associated with increased complication risk. This study was to investigate clinical viability and effectiveness of a technique designed to improve control of bone cement placement over standard methods when treating patients with symptomatic VCFs caused by malignancy. Methods: All patients had intractable pain determined to be associated with VCFs caused by metastasized malignancy. The procedure involved using a plasma-mediated radiofrequency-based device to debulk tissue and etch a void within the affected vertebral body and then filling the void and adjacent interstices with bone cement to stabilize the vertebral body and relieve pain. Results: 28 patients (36 vertebral bodies) with various types of metastatic lesions were treated. No evidence of cement extravasation outside the vertebral boundary was detected in 34/36 (94%) cases, even in cases with severe posterior cortical compromise and prominent epidural involvement pre-operatively. In the 2 observed cases, cement extravasation was clinically inconsequential. All treated patients reported marked pain relief. No patients were prevented from continuing other oncologic treatments. Conclusions: Tissue removal to create a void before injecting bone cement into a vertebral body compromised by malignancy may reduce the complication rate observed when injecting cement. This technique may redirect cement away from the spinal canal, notably in cases with posterior cortical defect and epidural extension, while also improving interdigitation of cement and decreasing risk of metastatic embolization. The resulting palliation potentially improves functionality and quality of life during and does not appear to affect the effectiveness of continued oncologic treatment. [Table: see text]

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Vertebral Augmentation for Compression Fractures Caused by Malignant Disease

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2010.0078 ◽

2010 ◽

Vol 8 (9) ◽

pp. 1095-1102 ◽

Cited By ~ 9

Author(s):

Rahul Rastogi ◽

Trusharth Patel ◽

Robert A. Swarm

Keyword(s):

Pain Relief ◽

Bone Cement ◽

Vertebral Body ◽

Malignant Disease ◽

Body Height ◽

Vertebral Compression Fractures ◽

Intractable Pain ◽

Vertebral Augmentation ◽

Vertebral Body Height ◽

Compression Fractures

Vertebral compression fractures are common in malignant disease and frequently cause severe back pain. However, management of that pain with conventional medical, radiotherapy, or surgical modalities is often inadequate. Vertebral augmentation techniques, such as vertebroplasty and kyphoplasty, are minimally invasive techniques in which methylmethacrylate bone cement is percutaneously injected into compressed vertebral bodies. Vertebral augmentation often improves mechanical stability of compressed vertebrae, provides pain relief, and may prevent progression of vertebral collapse. Kyphoplasty may provide increased chance for vertebral body height restoration, but the clinical importance of slight change in vertebral body height is unclear. Vertebral augmentation can be used in conjunction with other treatment modalities, and associated pain relief may improve patient tolerance of needed antitumor therapies, such as radiation therapy. Vertebral augmentation is generally very well tolerated, and complications associated with bone cement extravasation beyond the vertebral body have rarely been reported. Because it often provides good to excellent relief of otherwise intractable pain and is generally well tolerated, vertebral augmentation is becoming a first-line agent for management of painful vertebral compression fractures, especially in the setting of malignant disease.

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A pictorial classification atlas of cement extravasation with vertebral augmentation

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2011.05.009 ◽

2011 ◽

Vol 2011 ◽

pp. 302-305

Author(s):

B.T. Ragel

Keyword(s):

Vertebral Augmentation ◽

Cement Extravasation

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Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02480-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhongcheng An ◽

Chen Chen ◽

Junjie Wang ◽

Yuchen Zhu ◽

Liqiang Dong ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Bone Cement ◽

Vertebral Compression Fracture ◽

Univariate Analysis ◽

Compression Fracture ◽

Osteoporotic Vertebral Compression Fracture ◽

Vertebral Augmentation ◽

Surgical Methods

Abstract Objective To explore the high-risk factors of augmented vertebra recompression after percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fracture (OVCF) and analyze the correlation between these factors and augmented vertebra recompression after PVA. Methods A retrospective analysis was conducted on 353 patients who received PVA for a single-segment osteoporotic vertebral compression fracture from January 2017 to December 2018 in our department according to the inclusion criteria. All cases meeting the inclusion and exclusion criteria were divided into two groups: 82 patients in the recompression group and 175 patients in the non-compression group. The following covariates were reviewed: age, gender, body mass index (BMI), injured vertebral segment, bone mineral density (BMD) during follow-up, intravertebral cleft (IVC) before operation, selection of surgical methods, unilateral or bilateral puncture, volume of bone cement injected, postoperative leakage of bone cement, distribution of bone cement, contact between the bone cement and the upper or lower endplates, and anterior height of injured vertebrae before operation, after surgery, and at the last follow-up. Univariate analysis was performed on these factors, and the statistically significant factors were substituted into the logistic regression model to analyze their correlation with the augmented vertebra recompression after PVA. Results A total of 257 patients from 353 patients were included in this study. The follow-up time was 12–24 months, with an average of 13.5 ± 0.9 months. All the operations were successfully completed, and the pain of patients was relieved obviously after PVA. Univariate analysis showed that in the early stage after PVA, the augmented vertebra recompression was correlated with BMD, surgical methods, volume of bone cement injected, preoperative IVC, contact between bone cement and the upper or lower endplates, and recovery of anterior column height. The difference was statistically significant (P < 0.05). Among them, multiple factors logistic regression elucidated that more injected cement (P < 0.001, OR = 0.558) and high BMD (P = 0.028, OR = 0.583) were negatively correlated with the augmented vertebra recompression after PVA, which meant protective factors (B < 0). Preoperative IVC (P < 0.001, OR = 3.252) and bone cement not in contact with upper or lower endplates (P = 0.006, OR = 2.504) were risk factors for the augmented vertebra recompression after PVA. The augmented vertebra recompression after PVP was significantly less than that of PKP (P = 0.007, OR = 0.337). Conclusions The augmented vertebra recompression after PVA is due to the interaction of various factors, such as surgical methods, volume of bone cement injected, osteoporosis, preoperative IVC, and whether the bone cement is in contact with the upper or lower endplates.

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The Effect of Peritubal Infiltration with Bupivacaine and Morphine on Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

Pain Research and Management ◽

10.1155/2017/2454267 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Isra Karaduman ◽

Derya Karasu ◽

Canan Yilmaz ◽

Sedat Oner ◽

Hilal Erdem Solak ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Subcutaneous Tissue ◽

Randomized Study ◽

Double Blind ◽

Analgesic Consumption ◽

Vas Score ◽

Pain Scores ◽

Study Results ◽

The Mean ◽

Perinephric Fat

Objective. We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption in patients who underwent percutaneous nephrolithotomy. Material and Methods. Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL), in Group P (n=66), infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue, and skin under fluoroscopy. In Group C (n=64), none of the patients received a peritubal injection. In the first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands, and postoperative complications were compared between groups. Results. The mean VAS score at postoperative 8, 12, and 24 h and dynamic VAS score at postoperative 4, 8, 12, and 24 h were significantly lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand was significantly longer in Group P. Conclusion. Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption.

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Influence of the distribution of bone cement along the fracture line on the curative effect of vertebral augmentation

Journal of International Medical Research ◽

10.1177/0300060519864183 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4505-4513 ◽

Cited By ~ 3

Author(s):

Kai Xu ◽

Ya-Ling Li ◽

Fei Song ◽

Hua-Wei Liu ◽

Hua-Dong Yang ◽

...

Keyword(s):

Pain Relief ◽

Bone Cement ◽

Compression Fracture ◽

Cement Leakage ◽

Fracture Line ◽

Vertebral Augmentation ◽

Bilateral Group ◽

Significant Difference ◽

Cement Distribution ◽

Unilateral Group

Objective The present study was performed to evaluate the effect of different bone cement distributions along the fracture line on clinical and imaging outcomes of vertebral augmentation. Methods In total, 84 patients who underwent vertebral augmentation for a single osteoporotic vertebral compression fracture from January 2016 to August 2018 were retrospectively reviewed. These patients were divided into two groups according to the relationship between the bone cement distribution and the fracture line: the unilateral group (n = 23) and the bilateral group (n = 61). Postoperative clinical and imaging parameters were compared between the two groups. Results Statistical analyses showed no significant difference in postoperative pain relief, bone cement leakage, nerve injury, or new vertebral fracture between the two groups. Significant recovery from vertebral compression was observed in the bilateral group after surgery, but there was no significant difference in vertebral compression after surgery in the unilateral group. Conclusions Pain relief was similar for different types of cement distributions along the fracture line, but a bilateral cement distribution exhibited better recovery from vertebral compression and did not increase bone cement leakage in the vertebral augmentation procedure.

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