Asian Spine J.  2018 Oct;12(5):823-829. 10.31616/asj.2018.12.5.823.

Anterolateral Cervical Kyphoplasty for Metastatic Cervical Spine Lesions

• Sebaaly A
• Najjar A
• Wang Z
• Boubez G
• Masucci L
• Shedid D

• KMID: 2426642
• DOI: http://doi.org/10.31616/asj.2018.12.5.823

Abstract

STUDY DESIGN: Retrospective case series. PURPOSE: To evaluate the clinical and radiological efficacy of anterolateral kyphoplasty for cervical spinal metastasis. OVERVIEW OF LITERATURE: Although the spine is the third most common site of tumor metastasis, the cervical spine is the least commonly affected (incidence, 10%-15%). Surgical decompression is highly challenging because of the proximity of neural and vascular elements. Kyphoplasty for cervical spine metastasis has been described in small case reports with promising results.
METHODS
Retrospective analysis of a prospective collected single-center spine metastasis database was done for cervical kyphoplasty cases. Data pertaining to age, sex, primary tumor diagnosis, modified Tokuhashi score, Spinal Instability Neoplastic Score (SINS), preoperative Visual Analog Scale (VAS) score, and analgesic medication were extracted. Postoperative data included VAS score at postoperative day 1, duration of hospitalization, self-reported functional outcome, and VAS score at the last follow-up.
RESULTS
Eleven patients (mean age, 62.5 years) with cervical spine metastases were treated with 15-level kyphoplasty. Mean Tokuhashi score was 8.1, and mean SINS was 7.85. Mean preoperative pain score was 7.1, and 82% of patients used opioid analgesics. Mean total bleeding volume was 100 mL. Mean complication-free length of stay was 2.6 days with a decrease in postoperative pain (VAS score=2.8, p < 0.05). There was a 56% decrease in opioid dosage and the number of consumed analgesics (1.09, p =0.004). Eighty-two percent of the patients reported excellent improvement at the last follow-up self-assessment.
CONCLUSIONS
To our knowledge, this case series represents the largest series of vertebral augmentation using balloon kyphoplasty for cervical spinal metastasis. This technique is associated with low postoperative complications as well as significant decrease in pain, use of opioids, and length of hospital stay. The main indications for vertebral kyphoplasty are lytic lesions of the cervical spine, painful lesions refractory to medical treatment, SINS score of 6-10, and absence of posterior wall defect.

Keyword

Cervical vertebrae; Spine; Neoplasm metastasis; Kyphoplasty; Palliative care

MeSH Terms

Analgesics
Analgesics, Opioid
Cervical Vertebrae
Decompression, Surgical
Diagnosis
Female
Follow-Up Studies
Hemorrhage
Hospitalization
Humans
Kyphoplasty*
Length of Stay
Neoplasm Metastasis
Pain, Postoperative
Palliative Care
Postoperative Complications
Prospective Studies
Retrospective Studies
Self-Assessment
Spine*
Visual Analog Scale
Analgesics
Analgesics, Opioid