Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability Journal Article
| Authors: | Moussazadeh, N.; Rubin, D. G.; McLaughlin, L.; Lis, E.; Bilsky, M. H.; Laufer, I. |
| Article Title: | Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability |
| Abstract: | Background Context: Pathologic vertebral compression fractures (VCFs) represent a major source of morbidity and diminished quality of life in the spinal oncology population. Procedures with low morbidity that effectively treat patients with pathologic fractures are especially important in the cancer population where life expectancy is limited. Vertebroplasty and kyphoplasty are often not effective for mechanically unstable pathologic fractures extending into the pedicle and facet joints. Combination of cement augmentation and percutaneous instrumented stabilization represents a minimally invasive treatment option that does not delay radiation and systemic therapy. Purpose: The objective of the study was to evaluate the safety and efficacy of cement-augmented short-segment percutaneous posterolateral instrumentation for tumor-associated VCF with pedicle and joint involvement. Methods: Forty-four consecutive patients underwent cement-augmented percutaneous spinal fixation for unstable tumors between 2011 and 2014. Retrospective analysis of prospectively collected data, including visual analog pain scale (VAS) response score and procedural complications, was performed. Results: Patients with a median composite Spinal Instability Neoplastic Scale score of 10 (range=8-15) were treated with constructs spanning one to four disk spaces (median of two spaces, constituting 84% of all cases). The proportion of patients with severe pain decreased from 86% preoperatively to 0%; 65% of patients reported no referable instability pain postoperatively. There was one adjacent-level fracture responsive to kyphoplasty, and one case of asymptomatic screw pullout. Two patients subsequently required decompression in the setting of disease progression despite radiation; there was no perioperative morbidity. Conclusions: Percutaneous cement-augmented posterolateral spinal fixation is a safe and effective option for palliation of appropriately selected mechanically unstable VCF that extends into pedicle and/or joint. © 2015 Elsevier Inc. All rights reserved. |
| Keywords: | adult; clinical article; aged; cancer surgery; disease course; multimodality cancer therapy; cancer radiotherapy; outcome assessment; follow up; multiple myeloma; morbidity; retrospective study; external beam radiotherapy; bladder carcinoma; analgesia; pain assessment; postoperative pain; visual analog scale; spinal cord metastasis; small cell carcinoma; bone cement; kyphoplasty; non small cell lung cancer; laminectomy; spinal metastases; spinal cord decompression; lung edema; percutaneous vertebroplasty; spine stabilization; vertebroplasty; extravasation; compression fracture; necrotizing fasciitis; psoas abscess; staphylococcal bacteremia; spine fracture; human; male; female; priority journal; article; patient history of radiotherapy; vertebral compression fracture; spine fixation device; assessment of humans; percutaneous spinal fixation; posterolateral instrumentation; bone cement device; patient history of bone marrow transplantation; pedicle screw fixation device; spinal instability neoplastic scale score |
| Journal Title: | Spine Journal |
| Volume: | 15 |
| Issue: | 7 |
| ISSN: | 1529-9430 |
| Publisher: | Elsevier Science Inc. |
| Date Published: | 2015-07-01 |
| Start Page: | 1609 |
| End Page: | 1617 |
| Language: | English |
| DOI: | 10.1016/j.spinee.2015.03.037 |
| PROVIDER: | scopus |
| PUBMED: | 25828478 |
| DOI/URL: | |
| Notes: | Export Date: 2 September 2015 -- Source: Scopus |
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138Lis -
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146Laufer -
22Mclaughlin -
88Moss
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