[Clinical studies on treatment of patients with malignant spinal tumors by percutaneous vertebroplasty under guidance of digital subtraction angiography].

OBJECTIVE: To investigate the clinical therapeutic effects on malignant spinal tumors treated by percutaneous vertebroplasty (PVP) under the guidance of the digital subtraction angiography (DSA).
METHODS: A retrospective analysis was performed in 196 patients (99 males and 97 females, aged 23-85 years, averaged 60.4 years) with malignant spinal tumors, who underwent the PVP treatment combined with standard chemotherapy and other comprehensive treatment from January 2002 to January 2005. The malignant spinal tumors had their origins as follows: lung cancer (66 cases), breast cancer (55 cases), liver cancer (19 cases), colon cancer (15 cases), stomach cancer (9 cases), prostate cancer (12 cases), multiple myeloma (16 cases), and malignant lymphoma of the spine (4 cases). The metastatic tumors involved the cervical vertebra (32 cases), thoracic vertebra (93 cases), lumbar vertebra (71 cases), and spinal column, including 1 vertebral segment (135 cases), 2 segments (50 cases), and more than 3 segments (11 cases). During the follow-up survey, changes in the visual analogue pain scale (VAS) and changes in the X-ray measurements of the average anterior height, midline height, and posterior height of the diseased vertebra were observed.
RESULTS: The follow-up for 6 months to 3 years revealed that the percutaneous vertebroplasty on 279 vertebral segments had a success with an operational success rate of 100%. Bone cement was injected into the lesions 1-9 ml per segment of the spine. The postoperative X-ray and CT evaluations revealed that spinal stabilization was obtained in all the patients. After operation, 193 (98.5%)patients had an obvious decrease or disappearance of the pain in the lower back, and only 3 (1.5%) patients had no obvious improvement in the pain. There was a significant statistical difference in the VAS scores between before operation and after operation (P < 0.05). There were also significant statistical differences in the average anterior height of the diseased vertebra between before operation and after operation (15.71 +/- 2.80 mm vs. 16.61 +/- 3.01 mm), in the midline height (13.65 +/- 2.93 mm vs. 14.52 +/- 2.72 mm), and in the posterior height (23.67 +/- 2.81 mm vs. 23.70 +/- 3.13 mm, P < 0.05). The patients with lung or liver cancer had a mean survival time of 9 months after PVP; the patients with breast cancer, stomach cancer, prostate cancer, lymphoma, or other metastatic tumors had a mean survival time of 18 months. The patients with multiple myeloma had a mean survival time of 27 months. The differences were statistically different (P < 0.01).
CONCLUSION: PVP under the guidance of the DSA is an easier operation with a small wound and few complications. It can effectively alleviate the patient's pain due to metastatic spinal tumor, stabilize the spine, improve the patient's quality of life, and reduce the incidence of paraplegia.