scholarly journals Percutaneous Vertebroplasty Relieves Pain in Cervical Spine Metastases

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Li Bao ◽  
Pu Jia ◽  
Jinjun Li ◽  
Hao Chen ◽  
Yipeng Dong ◽  
...  
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Clinical Investigation ◽  
Spinal Metastasis ◽  
Cervical Vertebrae ◽  
Neck Disability Index ◽  
Cement Leakage ◽  
Anterolateral Approach ◽  
Tokuhashi Score ◽  
Analgesic Use ◽  
Tomita Score

Percutaneous vertebroplasty (PVP) has been shown to release spinal pain and stabilize the vertebral body. PVP is suggested as an alternative treatment in spinal metastasis. Although cervical metastases is less prevalent than thoracic and lumbar spine, PVP procedure in cervical vertebrae remains technical challenging. We retrospectively analyzed the data from patients (n=9) who underwent PVP using anterolateral approach to treat severe neck pain and restricted cervical mobility from metastatic disease. Patients were rated using modified Tokuhashi score and Tomita score before the procedure. Visual analog scale (VAS), neck disability index (NDI), analgesic use, and imaging (X-ray or CT) were evaluated before PVP and 3 days, 3 months, and 6 months after PVP. All patients were in late stage of cancer evaluated using modified Tokuhashi and Tomita score. The cement leakage rate was 63.6% (14 of the 22 vertebrae) with no severe complications. VAS, NDI, and analgesic use were significantly decreased 3 days after the procedure and remained at low level until 6 months of follow-up. Our result suggested PVP effectively released the pain from patients with cervical metastasis. The results warrant further clinical investigation.

scholarly journals Sarcopenia as a Prognostic Factor for 90-Day and Overall Mortality in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multicenter Retrospective Cohort Study

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1025-1036 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Brandon Michael Wilkinson ◽  
Zach Pennington ◽  
Yamaan S Saadeh ◽  
Darryl Lau ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Spinal Metastasis ◽  
Tertiary Care ◽  
Spinal Metastases ◽  
Psoas Muscle ◽  
Clinical Decision ◽  
Tokuhashi Score ◽  
Tomita Score ◽  
Overall Mortality

Abstract BACKGROUND Novel methods in predicting survival in patients with spinal metastases may help guide clinical decision-making and stratify treatments regarding surgery vs palliative care. OBJECTIVE To evaluate whether the frailty/sarcopenia paradigm is predictive of survival and morbidity in patients undergoing surgery for spinal metastasis. METHODS A total of 271 patients from 4 tertiary care centers who had undergone surgery for spinal metastasis were identified. Frailty/sarcopenia was defined by psoas muscle size. Survival hazard ratios were calculated using multivariate analysis, with variables from demographic, functional, oncological, and surgical factors. Secondary outcomes included improvement of neurological function and postoperative morbidity. RESULTS Patients in the smallest psoas tertile had shorter overall survival compared to the middle and largest tertile. Psoas size (PS) predicted overall mortality more strongly than Tokuhashi score, Tomita score, and Karnofsky Performance Status (KPS). PS predicted 90-d mortality more strongly than Tokuhashi score, Tomita score, and KPS. Patients with a larger PS were more likely to have an improvement in deficit compared to the middle tertile. PS was not predictive of 30-d morbidity. CONCLUSION In patients undergoing surgery for spine metastases, PS as a surrogate for frailty/sarcopenia predicts 90-d and overall mortality, independent of demographic, functional, oncological, and surgical characteristics. The frailty/sarcopenia paradigm is a stronger predictor of survival at these time points than other standards. PS can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates.

scholarly journals CMET-15. SARCOPENIA INDEPENDENTLY AND STRONGLY PREDICTS SURVIVAL IN PATIENTS UNDERGOING SPINE SURGERY FOR METASTATIC TUMORS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi54-vi54
Author(s):  
Hesham Zakaria ◽  
Yamaan Saadeh ◽  
Darryl Lau ◽  
Zachary Pennington ◽  
Ali Ahmed ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Clinical Decision ◽  
Surgical Morbidity ◽  
Tumor Spread ◽  
Tokuhashi Score ◽  
Tomita Score ◽  
Overall Mortality

Abstract INTRODUCTION Predicting survival and surgical morbidity in patients with spinal metastases would help guide clinical decision making and stratify treatments between surgical intervention and palliative care. This multi-center retrospective cohort study evaluates whether the frailty/sarcopenia paradigm, as measured by psoas size, is predictive of survival in patients undergoing surgery for spinal metastasis. METHODS 271 patients from four institutes who had undergone surgery for spinal metastasis were identified. Morphometric measurements were taken of the psoas muscle at the L4 vertebral level < 200d from surgery. Mortality hazard ratios were calculated using multivariate analysis, with variables included from past medical history, type and extent of tumor spread, type and intensity of surgery, and postoperative chemotherapy or radiation. RESULTS Psoas size was predictive of overall mortality; patients in the smallest tertile had shorter overall survival compared to the middle (OR 0.52, p< 0.001) and largest tertile (OR 0.45, p< 0.001). Psoas size predicted overall mortality more strongly than Tokuhashi score (OR 0.91, p= 0.010), Tomita score (OR 1.07, p= 0.04), and KPS (OR 0.99, p= 0.58). Psoas size was also predictive of 90-day survival; patients in the smallest tertile had shorter 90-day survival compared to the middle (OR 0.24, p= 0.003) and largest tertile (OR 0.16, p= 0.001). Psoas size predicted 90-day mortality more strongly than Tokuhashi score (OR 0.73, p= 0.002), Tomita score (OR 1.00, p= 0.92), and KPS (OR 0.98, p= 0.39). CONCLUSION In patients undergoing surgery for spine metastases, psoas size as a surrogate for frailty/sarcopenia predicts 90-day and overall mortality, independent of demographical, functional, oncological, and surgical characteristics. The sarcopenia/frailty paradigm is a stronger predictor of survival at these time points than the Tokuhashi score, Tomita score, and KPS. Psoas size can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates.

Percutaneous removal of a soft tissue cement leakage complicating a percutaneous vertebroplasty by the mean of a supple biopsy forceps

2013 ◽  
Vol 40 (2) ◽  
pp. 140-142 ◽  
Author(s):  
Jérémie Durrleman ◽  
Frédéric Clarençon ◽  
Evelyne Cormier ◽  
Lise Le Jean ◽  
Jacques Chiras
Keyword(s):  
Soft Tissue ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Biopsy Forceps ◽  
Percutaneous Removal ◽  
The Mean

scholarly journals Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell’s disease

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shou-qian Dai ◽  
Rong-qing Qin ◽  
Xiu Shi ◽  
Hui-lin Yang
Keyword(s):  
Blood Loss ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Intraoperative Blood Loss ◽  
Surgical Time ◽  
Significant Difference ◽  
Neurologically Intact ◽  
Operation Cost

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

scholarly journals Ascending Tonic Clonic Seizure Syndrome after Percutaneous Vertebroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Guido Zarattini ◽  
Adam Farrier ◽  
Federico Sibona
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Rare Complication ◽  
Cement Leakage ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Leg Pain ◽  
Compression Fractures ◽  
First Case ◽  
Seizure Syndrome ◽  
Osteoporotic Compression Fractures

Background Context. Cement leakage is not a rare complication of vertebroplasty, but ascending tonic clonic seizure syndrome is exceptionally rare. We herein report the first case to our knowledge of this complication related to vertebroplasty.Purpose. We herein report the first case of ascending tonic clonic seizure syndrome following epidural cement leakage after percutaneous vertebroplasty in a patient with multiple osteoporotic compression fractures.Study Design. Case report.Methods. A 64-year-old woman with T8, T10, L2, and L4 osteoporotic compression fractures underwent percutaneous vertebroplasty using polymethylmethacrylate. 40 minutes after the procedure the patient started suffering back and leg pain, having repetitive myoclonic jerks lasting 15 seconds of the lower extremities, spasm of the back, dyspnea, sinus tachycardia, hypoxemia, and metabolic acidosis.Results. The patient recovered completely due to a combination of early effective resuscitation and considered definitive management.Conclusions. Percutaneous vertebroplasty with polymethylmethacrylate is relatively safe but has few dangerous complications, which should be prevented by a meticulous technique and excellent image quality.

A Rare Presentation of Subacute Progressive Ascending Myelopathy Secondary to Cement Leakage in Percutaneous Vertebroplasty

2014 ◽  
Vol 93 (5) ◽  
pp. 431-436 ◽  
Author(s):  
Rohit Prakash Bhide ◽  
Apurba Barman ◽  
Shiela Mary Varghese ◽  
Ahana Chatterjee ◽  
Suraj Mammen ◽  
...  
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Rare Presentation

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

2020 ◽  
Author(s):  
Feng Miao ◽  
Xiaojun Zeng ◽  
Wei Wang ◽  
Zhou Zhao
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Body Height ◽  
Cement Leakage ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Vertebral Body Height ◽  
Low Viscosity ◽  
Pain Scores ◽  
Group A ◽  
Group B

Abstract Background: There is no consensus on the best choice between high- and low-viscosity bone cement for percutaneous vertebroplasty (PVP). This study aimed to compare the clinical outcomes and leakage between three cements with different viscosities in treating osteoporotic vertebral compression fractures.Methods: This is a prospective study comparing patients who were treated with PVP: group A (n = 99, 107 vertebrae) with high-viscosity OSTEOPAL V cement, group B (n = 79, 100 vertebrae) with low-viscosity OSTEOPAL V cement, and group C (n = 88, 102 vertebrae) with low-viscosity Eurofix VTP cement. Postoperative pain severity was evaluated using the visual analog scale. Cement leakage was evaluated using radiography and computed tomography.Results: There was no significant difference in the incidence of cement leakage between the three groups (group A 20.6%, group B 24.2%, group C 20.6%, P = 0.767). All three groups showed significant reduction in postoperative pain scores but did not differ significantly in pain scores at postoperative 2 days (group A 2.01 ± 0.62, group B 2.15 ± 0.33, group C 1.92 ± 0.71, P = 0.646). During the 6 months after cement implantation, significantly less reduction in the fractured vertebral body height was noticed in group B and group C than in group A (group A 19.0%, group B 8.1%, group C 7.3%, P = 0.009).Conclusions: Low-viscosity cement has comparable incidence of leakage compared to high-viscosity cement in PVP for osteoporotic vertebral compression fractures. It also can better prevent postoperative loss of vertebral body height.

scholarly journals P.133 A retrospective analysis of the clinical utility of the Tokuhashi scale, and its impact in surgical management of spinal metastatic disease

2016 ◽  
Vol 43 (S2) ◽  
pp. S51-S51
Author(s):  
E Leck ◽  
A Dakson ◽  
M Butler ◽  
G Thibault-Halman ◽  
S Christie
Keyword(s):  
Metastatic Disease ◽  
Clinical Utility ◽  
Spinal Metastasis ◽  
Spinal Instability ◽  
Vertebral Augmentation ◽  
Surgical Interventions ◽  
Tokuhashi Score ◽  
Group 3 ◽  
Surgical Group ◽  
Group 1

Background: The evaluation of patients presenting with spinal metastatic disease is often challenging. The Tokuhashi scale intends to facilitate this process. We conducted this study to investigate its clinical utility in surgical-decision making in patients with spinal metastasis. Methods: The oncology database was used to allocate 285 patients with spinal metastasis between 2010 and 2015. The Tokuhashi scale components were determined from a chart review. Results: Based on the Tokuhashi scale, there was 69.1% in the non-operative/radiation group (group 1), 23.2% in the palliative/excisional surgical group (group2) and 7.7% in the surgical group (group 3). Using Kaplan-Meiers estimate, survival time was significantly different across the three groups with means 232.8±30.8, 352.3±49.2 and 568.3±206.1 days, respectively. A significantly higher proportion of patients (84.6%) were treated non-surgically in group 1, compared to 45.5% in group 3 (X2=19.5, P<0.001). However, there was no correlation between the type of surgical interventions (i.e. instrumented decompression, decompression alone, percutaneous vertebral augmentation and instrumented vertebral augmentation) and the Tokuhashi score. Conclusions: This review illustrates the utility of the Tokuhashi scale in predicting survival. However, it does not address the new role of emerging different surgical strategies for the treatment of spinal metastasis and lacks information concerning spinal instability.

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