Efficacy and safety of vertebral stenting for painful vertebral compression fractures in patients with metastatic disease

Abstract

Background and Purpose:

Painful vertebral compression fractures in cancer patients reduce quality of life and may limit survival. We assessed pain relief, vertebral height restoration, and kyphosis correction following vertebral augmentation using a novel expandable titanium stent implant in cancer patients with painful vertebral compression fractures.

Materials and Methods:

Patients >18 years of age with metastatic disease who presented symptomatic compression fractures of vertebral bodies T5–L5, with or without a history of osteoporosis, were included in the study. Back pain at presentation, immediately after vertebral stenting, and at 1-, 3-, 6-, and 12-month follow-up was estimated using the visual analog scale (VAS). Vertebral height and local kyphotic angle (alpha angle) were measured on lateral standing X-ray before and 1–3 months after stenting.

Results:

Forty-one cancer patients with painful vertebral compression fractures underwent vertebral stenting procedures at 55 levels. There was no perioperative mortality and no significant complication. Median preoperative VAS was 8·0 (range 8–10), falling to 2·0 immediately postop (range 1–6, P  =  0·000) and 0 at all subsequent follow-up (P ≤ 0·012). Mean preoperative vertical height loss was 25·8% (range 0–84·0%) versus a postoperative mean of 18·0% (range 0–66·0%, P  =  0·000). Median pre- and postoperative kyphotic angle improved from 8·3° (range 0·2°–54·0°) to 7·1° (range 0·2°–25·0°, P  =  0·000). Wilcoxon signed rank test or student's t-test was used for comparisons.

Conclusions:

Vertebral augmentation using a novel vertebral stenting system provided immediate and enduring pain relief and improved vertebral height loss and kyphotic angle.

Keywords:

• Vertebral augmentation
• Vertebral compression fracture
• Metastatic disease
• Pain
• Vertebral stenting

Acknowledgements

The authors wish to thank Haim Ricas for the statistical analysis of pain, vertebral height loss, and kyphotic angle outcomes.