Vertebroplasty techniques take new directions

With the reputation of percutaneous vertebroplasty established for relieving osteoporotic pain, researchers are adapting and varying the technique for other conditions.

Percutaneous techniques could help improve treatment of hypervascular spinal tumors, according to Greek and Austrian researchers. Preoperative embolization with polyvinyl alcohol (PVA) can help stem excessive blood loss during tumor removal, though the technique is still in development.

Dr. Alexander Hadjipavlou of Iraklion, Greece, and colleagues used PVA embolization prior to surgical removal of 10 tumors, intraoperative cryoablation in four others, and both in one patient. Patients treated with embolization alone averaged nearly 3 liters of blood loss during resection, compared with an average of 500 mL for patients who had cryoablation.

"On the whole, we saw no morbidity and increased longevity with these techniques, though one patient lost 8 liters of blood. Embolization alone may not be enough," Hajipavlou said.

Austrian researchers used preoperative embolization with somewhat better results, completing the procedure in 28 patients with hypervascular bone metastases and using either PVA or gel foam.

Twenty-six of the tumors eventually were excised, one was reduced, and one patient underwent surgical exploration. Among the target masses, 23 of 28 had no major hemorrhage during surgery. A majority of patients had significant pain during the procedure, however, prompting lead author Dr. Horst Portugaller of Graz to emphasize the need for analgesia.

Swiss researchers have moved the vertebroplasty technique to the pelvis with good results in a preliminary trial. In 14 patients with 23 metastatic lesions, Dr. Amir Mehdizade and colleagues used fluoroscopy to inject polymethylmethacrylate into pelvic masses. They achieved complete pain relief in 92% of patients, and mobility improved in most as well.