Comparison of percutaneous vertebroplasty with and without interventional tumour removal for malignant vertebral compression fractures with symptoms of neurological compression.

ABSTRACT

OBJECTIVE: To compare the efficacy of percutaneous vertebroplasty (PVP) with and without interventional tumor removal (ITR) on malignant vertebral compression fractures and symptoms of neurological compression. MATERIALS AND METHODS: A total of 52 patients with malignant vertebral compression fractures and symptoms of neurological compression were selected for PVP and ITR (n = 24, group A) or PVP alone (n = 28, group B). A 14-G needle and a guidewire were inserted into the vertebral body, followed by sequential dilatation of the tract with the working cannula until the last working cannula reached the distal pedicle of the vertebral arch. ITR was performed with marrow nucleus rongeurs. Then, 5-10 mL cement was injected into the extirpated vertebral body. RESULTS: PVP procedures with and without ITR were successful in all patients, except for one patient in group A. The clinical assessment obtained at the initial and final follow-up indicated that the rates of full recovery and improved neurological compression symptoms were significantly higher in group A than in group B (P < 0.05). CONCLUSION: Treatment of malignant vertebral compression fractures with symptoms of neurological compression with PVP and ITR resulted in better intermediate-term clinical results in terms of improved neurological compression symptoms than the currently recommended approach of PVP. KEY POINTS • Percutaneous vertebroplasty (PVP) is now widely used for vertebral collapse due to malignancy • PVP can be coupled with interventional tumour removal (ITR) • PVP coupled with ITR provided better clinical results for neurological compression • PVP coupled with ITR provided better pain relief • PVP and ITR can remove tumour and helps prevent polymethyl methacrylate leakage.