Kyphoplasty and Vertebroplasty For Spinal Metastases

Some types of cancer have a tendency to spread (metastasize) to other parts of the body. These types of cancer include cancer of the lung, breast, colon and prostate. When cancer spreads to the spine, the part of the spine that is usually involved is the bony canal (vertebral body). Less frequently, the cancer involves the space around the nerves and spinal cord.

Metastases (the spread of cancer) to the spine can cause a fracture. This type of fracture (pathologic fracture) can be a source of the majority of “cancer pain” that a patient experiences. Bone pain, experienced by cancer patients at night, is usually a concerning warning sign of the spread of cancer to the spine.

Evaluation for spinal metastases is done by your oncologist who may order further tests as needed. The tests typically include CT scan, MRI, bone scan or PET scan.

Once a spinal metastasis is diagnosed, it is evaluated by a spine specialist for treatment. If the nerve roots or spinal cord are threatened from the metastases, an urgent operation may be needed to decompress and stabilize these elements. For a majority of patients, the vertebral body alone is involved causing bone pain. Pain relief is usually achieved by prescribing large doses of narcotics, which can compromise the patients quality of life.

Surgical treatment is an option for some spinal cancer patients. Two procedures for the right candidates are vertebroplasty, or a more recently available procedure called kyphoplasty. These surgical procedures relieve pain and minimize the use of narcotics.

Both procedures are performed on an out-patient basis, taking about 30-40 minutes per spinal level treated, and can be done under local injection with sedation of general anesthesia. X-rays are used to evaluate the spinal level that needs treatment. The patient lies on their belly and a small incision is made at the area for treatment. A channel is then established directly to the fractured spinal body.

If the procedure being performed is a vertebroplasty, bone cement is injected at this point at the fractured spinal level. In a kyphoplasty procedure, a balloon is introduced through the channel and inflated into the fractured level to restore height, pressing the fractured pieces into a compact mass, creating a space for the bone cement. After inflating the balloon and creating a space, bone cement is injected into the space. Patients who undergo vertebroplasty or kyphoplasty surgery achieve an 80%-90% immediate relief from pain.

Patients diagnosed with the spread of cancer to the spine should seek a neurosurgical consultation to evaluate the treatment options available to them, including vertebroplasty and kyphoplasty.