Percutaneous Vertebroplasty Combined with Transcatheter Arterial Infusion/Chemoembolization for the Treatment of Spinal Metastases

Abstract

Background: Spinal metastases are the most common type of metastatic bone tumors. Various therapeutic approaches have been used to treat spinal metastases, but traditional treatments are often limited and ineffective. Minimally invasive interventional technology has been successfully performed in the clinical setting. Objectives: This study is designed to evaluate the curative effect of spinal metastases treated by percutaneous vertebroplasty (PVP) and transcatheter arterial infusion/chemoembolization (TAI/TACE). Patients and Methods: A prospective study was performed for 18 consecutive patients with spinal metastases justified by imaging findings and pathology, including 12 men and 6 women, with the mean age of 64.56 ± 11.07 years (range, 50 - 90 years). All patients first underwent PVP and then TAI/TACE. The degree of pain relief was assessed with visual analogue scale (VAS) and WHO standard. The rating of the activity of daily life (ADL) was utilized to evaluate the quality of life. The activities of daily life (ADL) were evaluated with modified Barthel index system. The size of tumor and further bone invasion were evaluated three months after surgery. Results: We achieved a 100% success rate of all interventional operations. The effective rates of pain relief were respectively 94%, 94%, 89%, and 78% for one-day post-op, one-week post-op, one-month post-op, and three-months post-op. VAS for back pain was 7.7 ± 0.8, 5.3 ± 0.6, 3.4 ± 0.8, 2.0 ± 0.6, and 1.5 ± 0.6 for pre-operative, one-day post-op, one-week post-op, one-month post-op, and three-months post-op, respectively. The improvement of VAS was respectively 2.3 ± 0.6, 4.3 ± 0.9, 1.4 ± 0.8, and 1.8 ± 0.7. Preoperative and postoperative 3 months Barthel index was 45.3 ± 12.5 and 85.6 ± 14.2, respectively. There were significant difference in pain relief and the ability of daily life between pre-operation and post-operation time points (P < 0.05). There were no severe clinical or radiographic complications after interventions. Conclusion: PVP combined with TAI/TACE is a safe and effective technique for treatment of spinal metastases. PVP is effective for pain relief but has a limited antitumor effect, while TACE kills tumors more thoroughly compared to PVP. The combination of two therapies can make up for the shortcomings of each other and obtain definite effect, which markedly improves the patients’ living quality.