Vertebral Compression Fractures from Spinal Metastases: Imaging and Application of Kyphoplasty and Vertebroplasty (p. 63-71)
Authors: Roger M.L. Smith
Abstract: It is reported that 50-70% of patients with cancer have evidence of metastatic disease at the time of death and that 50% of skeletal metastases involve the spine. Often asymptomatic, vertebral metastases may only be discovered at routine metastatic workup. Pain, with or without neurological deficit is the predominant presenting symptom. This may be due to a tumor mass involving the vertebral body, extending to invade the paravertebral soft tissues, compression or invasion of adjacent nerve roots, destroying sufficient vertebral bone to cause a pathological fracture, spinal instability secondary to a fracture or more often associated with tumor destruction of the posterior elements and epidural compression of the spinal cord. Cord compression by tumor tissue and collapse of a vertebral body occurs in 5% of spinal metastases. Targeted therapy to these metastases and chemotherapy increases the likelihood of vertebral collapse. Vertebral augmentation has an established place in pain management of acute vertebral compression fracture with the possibility of reducing the fracture and restoring height to the vertebral body. Minimally invasive, these techniques can be performed as an adjunct to radiation to minimize deformity. This chapter will discuss the literature, the techniques and future directions of multimodality minimally invasive management of spinal metastases.