| Objective: To evaluate the safety and efficacy of PercutaneousVertebroplasty(PVP)combined with intraoperative biopsy in the treatment of thoracolumbar vertebral metastases.Methods: A total of 47 patients who were diagnosed as thoracolumbar vertebral metastasis from 2014 to 2019 in Department of Spinal Orthopaedics,the first affiliated Hospital of Guangxi Medical University,were selected as the study objects,including 24 males and 23 females,with an average age of 56.40years(29-82 years).Among them,26 patients were less than 60 years old and 21 patients were over 60 years old.The operation site included 69 vertebrae,including thoracic vertebrae(n=16)and lumbar vertebrae(n=53).Among the 47 patients,39 cases had definite cancer history including lung cancer(n=11),breast cancer(n=11),prostate cancer(n=5),liver cancer(n=4),rectal cancer(n=3),adrenal tumor(n=1),renal cancer(n=1),colon cancer(n=1),endometrial cancer(n=1)and laryngeal cancer(n=1);and other 8 cases were without definite history of tumor.All of those 47 patients had undergone PVP combined with biopsy.In this study,the pain of patients 1 day before operation,and 1 day,1month,3 months,6 months after operation were evaluated by using visual analog scale(VAS).The pain relief rate was calculated accordingly based on the VAS scores.Moreover,Karnofsky score was conducted to assess the life quality of those patients at the periods of before operation,1 month after operation and6 months after operation,respectively.Then the height changes of the anterior,middle and posterior edge of the diseased vertebra before and after operation were analyzed and compared to evaluate the recovery degree of the diseased vertebra height.Besides,the positive rate of pathological results was recorded and compared with that of those patients who had definite cancer history.Additionally,complications were recorded to evaluate the safety of PVP combined with intraoperative biopsy in the treatment of thoracolumbar vertebral metastasis.Results: In this study,PVP combined with intraoperative biopsy was successfully performed in 69 vertebrae of 47 cases.The average operationtime of each vertebra was about 43.41 min,and the average hospital staywas 3.94days(2～7 days).Postoperative pathological results indicated that,among the patients with the history of primary tumor(n=39),6 cases showed normal or necrotic bone and no tumor cells,and the positive rate ofprimary tumor was84.62%;while in those patients without a tumor history(n=8),2 cases showed osteoporotic fracture without tumor cells,while the rest of cases showed bone metastasis,with a positive rate of pathological result being 82.98%(39/47).The VAS score was 7.00±0.93 on the first day before operation,and 3.40±0.85,2.26±0.74,1.80±0.69 and 1.59±0.65 on the first day,one month,three months and six months after operation respectively;The VAS scores were statistically significant at all time points after operation compared with that before operation(P<0.001),indicating that PVP combined with intraoperative biopsy can significantly relieve the patients’ pain.The pain relief rate(%)was 51.61±9.17,68.6±8.72,74.40±9.25 and 77.26±8.82 on the first day,the first month,thethird month and the sixth month after operation,respectively,suggesting that PVP combined with intraoperative biopsy could also significantly alleviate the pain situation of patients,and the pain relief rate had reached a good level at all time points after operation.Analysis on the effect of different surgical approaches on postoperative pain relief showed that the Unilateral and bilateral puncture surgical approaches could obviously relief the pain of patients with thoracolumbar vertebral metastasis(P<0.001).However,no significant difference was observed between the two surgical approaches in postoperative pain relief(P>0.05).Compared with KPS scores at all time points before and after operation,the difference was statisticallysignificant(P<0.001),and the results showed that PVP could significantly improve the life quality for of MST patients.After comparing and analyzing the changes of disease vertebra height before and after operation,PVPwas found to have a certain recovery ability of disease,and the results showed that the anterior and central height of the vertebral body recovered1.38±0.87 mm and 1.56±1.00 mm respectively,but the posterior height of the vertebral body did not recover significantly.Among all69 vertebrae,cement leakage occurred in 22 diseased vertebrae,with the leakage rate of 31.88%,which did not cause obvious clinical symptoms,and no complications such as hematoma,incision infection,pulmonary embolism and adjacent vertebral fracture were observed.Conclusion: PVP combined with biopsy in the treatmentof thoracolumbar vertebral metastases has the advantages of less safe trauma,definite analgesic effect,and can improve the quality of life of patients with thoracolumbar metastases.It is a safe and effective supplement to the comprehensive treatment of thoracolumbar metastases,and it can also provide a safe and effective diagnosis and treatment for patients with unknown primary lesions. |
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