We aimed to investigate the clinical outcomes of percutaneous kyphoplasty (PKP) for spinal metastases in older adult patients with comorbidities.
Materials and Methods
Ninety-two older adults (age ≥ 60 years) with spinal metastases who underwent 148 PKP procedures were retrospectively analyzed. Tokuhashi scores, Tomita scores, age-adjusted Charlson Comorbidity Index (aCCI) scores, and American Society of Anesthesiologists (ASA) scores were evaluated before the procedure. The visual analog scale (VAS), Oswestry Disability Index (ODI), vertebral body height (VBH), and quality of life (QoL) were used to assess the efficacy of the procedure. Clinical safety was evaluated based on periprocedural complications.
Tokuhashi scores and Tomita scores were 7.3 ± 4.0 and 5.8 ± 2.1, respectively. Excluding cancer-related factors, twelve patients (13.0%) had aCCI scores ≥4. Forty-three patients (46.7%) had ASA status ≥ III. Compared to preoperative status, average VAS scores, ODI scores, VBH variation, and QoL scores significantly improved at each follow-up examination point after PKP (p < 0.001). No major complications occurred, nor was there decompensation of comorbidities in the perioperative period. Seventeen segments (11.5%) of twelve patients (13.0%) suffered bone cement leakage. Among them, one patient suffered intercostal neuralgia cured by steroid injection, and the other patient suffered hyperesthesia, which disappeared after taking gabapentin (0.3 g, bid) for five weeks. Another minor complication of local hematoma occurred in one patient, which spontaneously resolved without surgical intervention.
PKP serves as a safe approach to provide significant pain relief, vertebral body height restoration, and QoL improvements for spinal metastases in older adults, independent of underlying disease.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Geriatric Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- State of the art treatment of spinal metastatic disease.Neurosurgery. 2018; 82: 757-769
- En bloc resection of solitary functional secreting spinal metastasis.Global Spine J. 2016; 6: 277-283
- Outcomes in the radiosurgical management of metastatic spine disease.Adv Radiat Oncol. 2019; 4: 283-293
- Evaluation of a bipolar-cooled radiofrequency device for ablation of bone metastases: preclinical assessment in porcine vertebrae.Spine J. 2014; 14: 361-370
- Safety and clinical effectiveness of percutaneous vertebroplasty in the elderly (≥80 years).Eur Radiol. 2016; 26: 2352-2358
- Scoring system for the preoperative evaluation of metastatic spine tumor prognosis.Spine (Phila Pa 1976). 1990; 15: 1110-1113
- Surgical strategy for spinal metastases.Spine (Phila Pa 1976). 2001; 26: 298-306
- Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer.Cancer. 2008; 112: 2384-2392
- Clinical evaluation of percutaneous kyphoplasty in the treatment of osteolytic and osteoblastic metastatic vertebral lesions.Int J Surg. 2016; 30: 161-165
- A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty.Spine (Phila Pa 1976). 2014; 39 (26 Spec No.):B19–26
- Society of Interventional Radiology clinical practice guidelines.J Vasc Interv Radiol. 2003; 14: S199-S202
- Quality assurance guidelines for percutaneous vertebroplasty.Cardiovasc Intervent Radiol. 2006; 29: 173-178
- Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty.J Vasc Interv Radiol. 2003; 14: 827-831
- Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial.Lancet Oncol. 2011; 12: 225-235
- Factors affecting delayed Union of Vertebral Fractures Following Percutaneous Kyphoplasty.Pain Physician. 2017; 20: E241-E249
- Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures.Eur Spine J. 2020; 29: 2568-2575
- Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up.Acta Radiol. 2006; 47: 369-376
- Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients.J Neurosurg. 2003; 98: 21-30
- Percutaneous vertebroplasty vs balloon kyphoplasty in the treatment of newly onset osteoporotic vertebral compression fractures: a retrospective cohort study.Medicine (Baltimore). 2019; 98e14793
- Multilevel percutaneous kyphoplasty in painful osteolytic vertebral metastases: a study of the efficacy and safety.J Pain Res. 2019; 12: 1053-1060
- Safety of percutaneous vertebroplasty for the treatment of metastatic spinal tumors in patients with posterior wall defects.Eur Spine J. 2015; 24: 1768-1777
- Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications.Spine (Phila Pa 1976). 2009; 34: 1228-1232
- Identification of risk factors for the occurrence of cement leakage during percutaneous vertebroplasty for painful osteoporotic or malignant vertebral fracture.Spine (Phila Pa 1976). 2014; 39: E693-E700
- Cause analysis of open surgery used after percutaneous vertebroplasty and kyphoplasty.Med Sci Monit. 2016; 22: 2595-2601
- Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures.Cardiovasc Intervent Radiol. 2008; 31: 937-947
- Clinical and radiographic results of balloon kyphoplasty for treatment of vertebral body metastases and multiple myelomas.J Clin Neurosci. 2010; 17: 219-224
- Safety and efficacy of percutaneous vertebroplasty and interventional tumor removal for metastatic spinal tumors and malignant vertebral compression fractures.AJR Am J Roentgenol. 2014; 202: W298-W305
- Percutaneous vertebroplasty for pain management in patients with multiple myeloma: is radiofrequency ablation necessary.Cardiovasc Intervent Radiol. 2014; 37: 203-210
- The current status and future of radiotherapy for spinal bone metastases.J Orthop Sci. 2015; 20: 585-592
- Ablation, consolidation and radiotherapy for the management of metastatic lesions of the spine: impact on the quality of life in a mid-term clinical and diagnostic follow-up in a pilot study.Med Oncol. 2020; 37: 53
Published online: December 06, 2022
Accepted: November 30, 2022
Received in revised form: November 18, 2022
Received: August 5, 2022
© 2022 Elsevier Ltd. All rights reserved.