J Korean Neurosurg Soc.  2017 Feb;60(2):189-194. 10.3340/jkns.2016.0909.003.

Bone Cement-Augmented Percutaneous Screw Fixation for Malignant Spinal Metastases: Is It Feasible?

• Kim P
• Kim SW

• KMID: 2374880
• DOI: http://doi.org/10.3340/jkns.2016.0909.003

Abstract

OBJECTIVE
We evaluated the validity of bone cement-augmented percutaneous screw fixation for treating malignant spinal metastases.
METHODS
Between 2011 and 2015, 14 patients (eight men and six women) who underwent bone cement-augmented percutaneous screw fixation for malignant spinal metastases were enrolled in this study. Their life expectancy was considered to be more than one month and less than one year, based on the revised Tokuhashi scoring system. Clinical findings including the back pain scale score, functional outcome, procedure related complications, and survival were assessed preoperatively, postoperatively, and then six months after the procedure.
RESULTS
Twelve of the patients (86%) survived up to six months after the procedure. Three required mini-open decompressive laminectomy for severe epidural compression. Bone cement-augmented percutaneous screw fixation was performed one level above, one level below, and at the pathologic level itself. The mean operation time was 60 minutes (45-180) and blood loss was less than 100 mL. Prior to surgery, the mean pain score on the visual analogue scale was 8.8, while one month after the procedure, it had reduced to 3.0; this improvement was maintained until the six-month assessment in the surviving patients. All patients were able to sit within the first two days after surgery, and no patient experienced neurological deterioration at the one-month follow up after the surgery. No patient experienced screw loosening during the six months of follow-up. Asymptomatic cement leakage into the epidural space was observed in two patients, but no major complications were observed.
CONCLUSION
For selected patients with malignant spinal metastases, bone cement-augmented percutaneous screw fixation can provide significant pain relief and improve quality of life.

Keyword

Screw; Metastasis; Percutaneous

MeSH Terms

Back Pain
Epidural Space
Follow-Up Studies
Humans
Laminectomy
Life Expectancy
Male
Neoplasm Metastasis*
Quality of Life

Figure

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  Fig. 1 Improvement of back pain scale. *p<0.05, preoperative versus 6 months. VAS was not obtainable in 2 patients who had died and 1 patient who showed hepatic coma at 6 months. VAS: visual analogue scale.

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  Fig. 2 Neuroimaging studies obtained in a patient with colon cancer that metastasized to the L2 level. A and B: Enhanced T1-weighted sagittal and axial images show significant involvement of posterior elements with epidural compression of the cal sac. C: Computed tomography scan reveals destruction of the right L2 pedicle. D and E: Simple radiographs taken at 1 month after bone cement-augmented percutaneous short segment fixation demonstrate the three level stabilization.

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  Fig. 3 Neuroimaging studies obtained in a patient with adenocarcinoma of lung that metastasized to the T11 level. A and B: T2- weighted sagittal image and computed tomography scan reveal severe cord compression and destruction of vertebral body and right pedicle at T11. C and D: Simple radiographs taken at 1 month after bone cement-augmented percutaneous short segment fixation show the three level stabilization.

Reference

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