Abstract: BACKGROUND:  Percutaneous vertebroplasty is a palliative treatment for spinal metastases. However, cement leakage is common in patients with extensive destruction of cortical bone (≥ 1/3). Therefore, it is a relative contraindication that the posterior margin of cortical bone of vertebral body is incomplete in the metastases of thoracolumbar spine.
OBJECTIVE:  To observe the safety and efficacy of percutaneous vertebroplasty with mesh-hold in the treatment of spinal metastases with extensive destruction of cortical bone.
METHODS:  Twenty-one patients suffered from spinal metastases with destruction of cortical bone of vertebral body were treated with percutaneous vertebroplasty with mesh-hold in the Luohe Central Hospital from January 2013 to January 2018 and radiotherapy of the involved vertebrae after operation, including 10 males and 11 females at the age of 42-87 years. Before operation, 3 days and 6 months after operation, X-ray films were taken to measure the height of anterior edge of diseased vertebrae. Visual analogue scale was used to evaluate the pain. Abilities of daily life scale was used to evaluate the quality of life. Oswestry disability index was used to evaluate the changes of neurological function. This study was approved by the Ethics Committee of Luohe Central Hospital (approval No. LH-KY-2013-002-117).
RESULTS AND CONCLUSION:  (1) All the 21 patients completed the operation successfully. During bone cement injection into the mesh-hold, the bone cement oozed out into the bone trabecula through the mesh hole in a linear fashion when the mesh-hold expanded to a certain extent, and the vertebral body was elevated to a certain degree simultaneously. (2) The follow-up period ranged from 6 to 21 months. No leakage of bone cement to the front of vertebra, intervertebral disc or spinal canal, no vascular embolism, pulmonary embolism or wound infection occurred. (3) The height of anterior edge of vertebra was higher at 3 days and 6 months after operation than that before operation in 21 patients (P < 0.05). Visual analogue scale scores were lower at 3 days and 6 months after operation than that before operation (P < 0.05). Abilities of daily life scale and Oswestry disability index were lower at 6 months after operation than that before operation (P < 0.05). (4) These findings suggested that for the patients suffered from spinal metastases who have lost the chance of complete resection, even if there is extensive destruction of vertebral cortical bone (accounting for more than 1/3 of the whole vertebral cortical bone), percutaneous vertebroplasty with mesh-hold can still be performed. Its safty is high, and it can not only effectively reduce local pain, maintain the height of the vertebral body, delay the collapse of the vertebral body, but avoid the leakage of bone cement.

Key words: spinal metastases, mesh-hold, orthopedic implants, percutaneous vertebroplasty, tissue engineering, polymethyl methacrylate bone cement