Vesselplasty For Axial Metastatic Carcinoma And Its Related Basic Investigation

Background:Although the incidence of metastatic cancer of the axis is not high,severe pain will occur once it occurs.If a fracture compresses the spinal cord,it will have fatal consequences.The traditional surgical methods of open surgery have caused more trauma to patients and they cannot achieve better results for patients with limited survival time.For axial surgery,the main purpose is to maintain the stability of the vertebral body and relieve pain.Therefore,it is very necessary to find a treatment method that meets the above objectives,and this method should be less invasive and safe and effective.Vesselplasty has been used in the treatment of thoracic and lumbar spinal metastatic cancer since it was invented in 2004.Compared with PKP / PVP,the effect is more significant.And the rate of cement leakage is lower or even 0.The application of vesselplasty in the treatment of metastatic carcinoma of the axis can better maintain the stability of the vertebra and relieve pain,especially in the treatment of vertebral body tumors with posterior wall rupture.Effectively prevent serious complications due to bone cement leakage.At present,no literature has reported the application of vesselplasty in the treatment of axial metastatic cancer.Objective:To analyze the clinical effects of vesselplasty which was performed in axis,and carry out relevant research on bone cement filling rate.Methods:We retrospectively analyzed the effect of 3 patients with metastatic carcinoma of the vertebrae undergoing vesselplasty and 1 primary tumor of the axis through the posterior cervical spine surgery from September2017 to September 2019.The clinical manifestations of patients before,24 hours,1 week,and 3 months after surgery were compared,including:visual analogue score(VAS)and patient's cervical spine activity.CT scan of the axis was performed before and 1 day after operation to observe the integrity of the posterior edge of the vertebral body,the position and shape of the mesh bag after operation,and the volume of bone cement and whether there was leakage.MRI examinations were performed before and after surgery to determine the location of the tumor and compare the tumor size before and after surgery.The surgical approach and anesthesia were selected based on the above imaging data and the actual situation of the patient.And based on the above-mentioned imaging data,using computer software to study the filling rate of bone cement.RESULTS:A total of 4 patients were included in the study,3 of them underwent vesselplasty with surgical anterior approach and one patient underwent posterior cervical decompression and fixation combined with vertebroplasty.Among them,patients undergoing simple vesselplasty had immediate relief of pain after surgery,which decreased to 3 points,4points,and 3 points,respectively.Postoperative pain was relieved immediately,which decreased to 3 points,4 points,and 3 points,respectively.24 hours after surgery,the VAS score decreased to 1 point,2points,and 2 points.Cervical spine mobility(spinning)was changed from less than 15 °(8 °,13 °,9 °)before surgery to 31 °,44 °,42 °,which was significantly improved compared with before surgery.One week after the operation,no pain was detected in all three patients,and the cervicalspine could be moved to different degrees under the protection of a cervical collar.Three months after the operation,three patients and their families said that the quality of life of the patients had been significantly improved,no neck pain was felt,and some regular neck activities could be performed without the neck support.Patients who underwent posterior cervical decompression and fixation combined with vertebroplasty had no immediate relief of pain due to open surgery.The VAS score was 6 points.At 24 hours after surgery,the VAS score decreased to 5 points,and cervical mobility was poor.One week after surgery,the VAS score was reduced to 3 points.Three months after the operation,the patient could barely feel pain,and the VAS score was 1.Because the cervical spine was fixed by surgery,the mobility of the cervical spine was basically lost.Conclusions:1.Vesselplasty for axial metastatic carcinoma is a relatively safe and effective surgical treatment for metastatic carcinoma of the axis.Because the design of the mesh bag is to ensure that the bone cement is injected into the vertebral body in an orderly and orderly manner,so it can maximally prevent bone cement from leaking into the spinal canal through the ruptured posterior wall of the vertebral body,thereby avoiding the injury of the high cervical spinal cord during operation and causing death of the patient during the operation.2.Vesselplasty for axial metastatic carcinoma can very well stabilize pathological fractures caused by metastatic cancer of the vertebrae and relieve neck pain caused by cancer metastasis.3.In this study,a computer three-dimensional model is used to calculate that when the filling rate of bone cement for tumor tumors reaches about30%,a clear surgical treatment effect can be achieved.Preoperative,postoperative and long-term follow-up results and data show that when the filling rate of bone cement to the tumor body reaches about 30%,it can limit the further growth of metastatic tumors within the vertebral body,which can relieve local tumors to the axis.Neck pain caused by damage.4.Compared with posterior surgery,vesselplasty being used with anterior cervical incision,the surgical injury is smaller,the anterior lower edge of the vertebral body of the pivotal vertebra can be observed more intuitively,and the needle insertion point is determined more safely,Needle insertion direction and depth,so that the accuracy of the operation is further improved,and the safety is guaranteed.5.Compared with anterior incision vesselplasty and posterior incision with fixation combined with axial vertebral angioplasty,although bone cement injection can effectively relieve the pain caused by the destruction of the axial spine tumor,simpler,less damaged,can better protect cervical spine function,and significantly improve the quality of life of patients with advanced tumors?6.Although there are few cases in this article,according to the PKP /PVP reported in a large number of literatures for the effect of tumor treatment,combined with the analysis of the nearly 2,000 cases of PKP /PVP surgery completed before and after a certain period of follow-up analysis,the anterior cervical approach vesselplasty can safely and effectively relieve patients' pain,restore vertebral body stability,restore cervical spine mobility,and reach the predetermined goal of the surgical treatment we established before surgery.7.Through our surgical experience,it is better to use nasal intubation for the spine surgery in the atlantoaxial region,so that the anatomicallandmarks of the atlantoaxial vertebra can be better observed during fluoroscopy,which lays the foundation for successful surgery.