Minimally invasive treatments of spinal metastases: vertebroplasty, radiofrequency ablation and radiation therapy

doi:10.3969/j.issn.2095-4344.2015.16.029

Abstract

Abstract:

BACKGROUND: The development of minimally invasive technology significantly reduces the occurrence of surgical complications due to spinal metastases. Currently, the minimally invasive treatment basically has three broad categories: vertebral cement augmentation, radiofrequency ablation combined with vertebroplasty, intraoperative radiotherapy combined with vertebroplasty.
OBJECTIVE: To summarize the research progress of three kinds of minimally invasive treatments for spinal metastases.
METHODS: PubMed and Wanfang databases were searched using the keywords of “spinal metastases, vertebroplasty, radiofrequency ablation, radiotherapy” in English and Chinese, respectively.
RESULTS AND CONCLUSION: Vertebral cement augmentation with good analgesic effect has been used widely, and the efficiency is up to 80%-90%. But its effect to kill tumors is very limited that is unable to control tumor growth. Radiofrequency ablation and radiation can kill the tumor, but cannot rebuild the vertebral stability. Therefore, the combination of different technologies can improve the therapeutic effect on spinal tumors. In recent years, intraoperative radiation and implantation of radioactive particles or radioactive bone cement have been developed as new technologies. However, there is no conclusion that these new technologies have better outcomes than the vertebral cement augmentation because of less reports and lack of long-term follow-up. Especially in the metastatic patients with damaged vertebral posterior wall and tumors invaded into vertebral canal, the risk of nerve function damage caused by bone cement leakage is still very high, even after many attempts. Above all, there is no a perfect minimally invasive treatment for spinal metastases.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: Biocompatible Materials, Vertebroplasty, Surgical Procedures, Minimally Invasive

CLC Number:

R318

Guan Kai, Liu Chuan, Li Fang. Minimally invasive treatments of spinal metastases: vertebroplasty, radiofrequency ablation and radiation therapy[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(16): 2613-2618.

Figures/Tables 1

2.1 椎体骨水泥增强椎体骨水泥增强包括椎体成形及椎体后凸成形治疗。 2.1.1 安全性和止痛效果因脊柱转移瘤位置变化大，很多对椎体后壁有侵及甚至对硬膜囊有轻度压迫，所以对脊柱转移瘤患者行骨水泥增强较对骨质疏松压缩骨折患者风险更高。Calmels等[11]报告脊柱转移瘤患者行骨水泥增强严重并发症发生率为0-11.5%(平均2%)，死亡率为0-7%。注入骨水泥4 mL以上发生并发症概率明显增高，虽然这一数字文献支持有限，但骨水泥注入量与并发症是明显相关的[12]。 Hadjipavlou等[13]经过对既往文献总结并进行统计分析表明，椎体成形对椎体肿瘤的疼痛缓解率为75.9%-92.5%；椎体后凸成形对椎体肿瘤的疼痛缓解率为75.6%-98.2%，两者之间比较差异无显著性意义。癌症骨折研究小组(Cancer Fracture Evaluation，CAFÉ)发表1篇多中心前瞻性随机对照的高等级文献，将分布在欧洲、美国、加拿大和澳大利亚的22个中心的134例脊柱转移瘤疼痛患者随机分到椎体后凸成形组(n=70)和非手术组(n=64)，最小年龄22岁，肿瘤侵及1-3个节段，随访结果显示椎体后凸成形可明显快速有效减轻疼痛，减少致残率，提高患者生活质量，减少止痛药的用量[14]。骨水泥增强的止痛机制有化学毒性作用、热坏死效应及固化对骨折椎体的力学稳定作用，现阶段的研究认为椎体成形维持椎体力学的稳定性是椎体成形缓解疼痛的主要机制。Nakano等[15]将无毒性磷酸钙作为骨水泥对患者行椎体成形，实验组和对照组相比也能很好地缓解患者的疼痛症状，所以作者认为骨水泥的化学毒性不是缓解患者疼痛的主要因素。Deramon等[16]研究发现甲基丙烯酰甲酯骨水泥在聚合过程中能够产生热量，但椎管内的温度低于41 ℃，所以他们认为疼痛的缓解不可能为椎体神经末梢热坏死所致。Verlaan等[17]对羊腰椎行椎体成形的研究发现，在骨水泥与骨组织相邻界面平均最高温度为44.6 ℃，这样的温度不足以导致局部组织坏死。Anselmetti等[18] 则首次对腰椎骨质疏松性骨折患者进行研究，发现11种不同的骨水泥单体在聚合过程中释放的热量均不能使温度维持45 ℃以上超过 30 min，所以作者认为骨水泥的聚合放热不会导致感觉神经的损伤。综上所述，这些研究结果表明骨水泥单体"

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