#277 Malignant VCF. Is it beneficial to Do an Anatomical Reconstruction of the Vertebra?
Poster Presented by: D.C. Noriega Gonzalez
D.C. Noriega Gonzalez (1,2)
R. Hernandez Ramajo (3)
A. Kruger (4)
F. Ardura (1)
(1) Valladolid University, Spine Dept, Valladolid, Spain
(2) Royal Academy of Medicine and Surgery, Valladolid, Spain
(3) Valladolid University, Valladolid, Spain
(4) Marburg University, Marburg, Germany
Spine disease due to malignant lesión is commom among cáncer patients. The incidence of spine malignant disease varies from 30% to 70% depending on the primary tumor, tough not all of them are symptomatic. Incidence of VCF in multiple mieloma is 24%, in breast cáncer is 14%, 6% among prostate cáncer and around 10% of lung cáncer patietns will develop symptoms, and about 40% to 70% will have a multiple level involvement.
In previous publications the main goal for these group of patients was related to the pain treatment not evaluating the ability to control the biomechanical chages. Thanks to the increase of the life expectancy in this group of patients there is an increasing probaility for those biomechanical changes to develop clinical symptoms.
Material and Methods: A retrospective study from January 2009 to December 2012, including all the patients who underwent surgery for malignant VCF, has been performed under the approval of Valladolid University Ethics Comittee.
32 patients with malignant disease of the spine who suffered a VCF underwent surgery on 52 vertebral levels(19 single level, 13 multiple level). 18 male, 14 female. 16 due to hematologic diseases, 16 metastasis of solid tumors.
The average time of follow-up has been 20,25 months (2-50), within the group 3 patients died in beteween 2-6 months. In total 13 patients have died throughout the study with an average follow-up of 14,9 (2-36) months and 19 patients, with 33 VCF, are under active follow-up control with and average follow-up of 21,2 (5-50) months.
MIS transpedicular reduction of the VCF plus high viscosity cementoplasty.
Results: VAS preop 7,15 (5,8-8,1), VAS postop 1,81 (0-4), VAS 12 months 1,94 (0-5), VAS May 2013 2,23 (0-5), (p< 0,005).
The leakage ratio was 15,6% (5 cases), 2 cases in hematologic group and 3 cases in the solid metástasis group. Adjacent fractures 9,4% (3), all of them in the group of solid metastasis and 0 cases of VB recolapse.
Conclusions: Anatomical restoration of malignant VCF is a safe and effective procedure in the short term follow-up to control the symptoms and avoid complications.
The ability to control the biomechanial changes (sagital balance and transfer load through the disc) allows to control the long term complications (adjacent fractures, facet degenerations, recolapse).
This capacity to control the long term consequences increases the quality of life ina well selected group of cáncer patients.
A proper evaluation of the patients (type of tumor, quality of life, life expectancy, risk of future complications) should be realized to determine the indication for anatomical restoration.