Vesselplasty: A New Minimally Invasive Approach to Treat Pathological Vertebral Fractures in Selected Tumor Patients – Preliminary Results

Abstract

Purpose: To evaluate the effectiveness and safety of percutaneous vesselplasty in pathological vertebral fractures of the thoracolumbar spine in selected tumor patients.

Materials and Methods: Eleven pathological vertebral fractures in nine patients were treated with vesselplasty (Vessel-X^®, MAXXSPINE). Nine of eleven vertebras (81.8 %) had major posterior wall deficiency (> 30 %). Clinical and radiological (CT) measures were obtained before and 3 months after the procedure.

Results: The mean VAS improved significantly from preoperative to postoperative (6.9 ± 2.2 to 3.7 ± 2.3; p < 0.05), as did the ODI (59.7 %± 19.2 % to 40.3 %± 24.0 %; p < 0.05). The physical component summary of the SF-36 was significantly improved by the operation (19.2 ± 8.0 to 31.0 ± 16.5; p < 0.05). Symptomatic cement leakage or other operation-associated complications were not observed. Three patients were primarily treated with concomitant minimally invasive stabilization via fixateur interne. One patient had to undergo minimally invasive stabilization via fixateur interne 4 months after vesselplasty due to further collapse of the treated vertebral body.

Conclusion: From these preliminary results, vesselplasty appears to be a treatment option worth considering in pathological vertebral fractures, even in the case of posterior wall deficiency. Selected tumor patients might benefit from vesselplasty as a minimally invasive procedure for stabilization of the fractured vertebra, pain control, and improvement in body function and quality of life. Long-term prospective studies with a larger sample size are required to validate these results.

Zusammenfassung

Ziel: Bewertung von Wirksamkeit und Sicherheit der perkutanen Vesselplastie zur Behandlung pathologischer Wirbelkörperfrakturen der thorakolumbalen Wirbelsäule bei ausgewählten Patienten.

Material und Methoden: Elf pathologische Wirbelkörperfrakturen bei 9 Patienten wurden mittels Vesselplastie (Vessel-X^®, MAXXSPINE) behandelt. Neun der 11 Wirbelkörper (81,8 %) wiesen eine deutliche Beteiligung der Wirbelkörperhinterwand (> 30 %) auf. Klinische und radiologische (CT) Parameter wurden vor und 3 Monate nach der Therapie erhoben.

Ergebnisse: Der durchschnittliche Schmerzwert der VAS verbesserte sich signifikant von prä- zu postoperativ (6,9 ± 2,2 vs. 3,7 ± 2,3; p < 0,05) ebenso wie der ODI (59,7 ± 19,2 vs. 40,3 ± 24,0 %; p < 0,05). Die körperliche Summenskala des SF-36 verbesserte sich durch die Operation signifikant (19,2 ± 8,0 vs. 31,0 ± 16,5; p < 0,05). Symptomatische Zementextravasation oder operationsassoziierte Komplikationen wurden nicht beobachtet. Drei Patienten wurden initial mit gleichzeitiger minimalinvasiver Stabilisierung mittels Fixateur interne behandelt. Ein Patient musste sich einer minimalinvasiven Stabilisierung mittels Fixateur interne 4 Monate nach der Vesselplastie unterziehen, da der behandelte Wirbelkörper weiter eingebrochen war.

Schlussfolgerung: Ausgehend von diesen vorläufigen Ergebnissen scheint die Vesselplastie sogar bei Beteiligung der Wirbelkörperhinterwand eine erwägenswerte Therapieoption für pathologische Wirbelkörperfakturen darzustellen. Ausgewählte Tumorpatienten können von der Vesselplastie als minimalinvasives Verfahren zur Stabilisierung des frakturierten Wirbelkörpers, Schmerzbehandlung sowie Verbesserung der körperlichen Funktion und Lebensqualität profitieren. Langfristige prospektive Studien mit einer größeren Fallzahl sind erforderlich, um diese Ergebnisse zu validieren.

Key words

spine - surgery - metastases instrumentation - percutaneous - interventional procedures

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