Percutaneous Vertebroplasty Combined With ¹²⁵I Seed Implantation For Treatment Of Spinal Metastatic Epidural Spinal Cord Compression

Objective To evaluate the efficacy of percutaneous vertebroplasty（PVP）combined with iodine-125(¹²⁵I)seed brachytherapy in treating spinal metastatic epidural spinal cord compression（MESCC）and to assess the changes in the epidural spinal cord compression（ESCC）scale on magnetic resonance imaging（MRI）.Methods A total of 37 consecutive patients with 39 MESCC lesions treated with PVP combined with ¹²⁵I seed brachytherapy at our institution from January 2014 to June 2019 were retrospectively analyzed.The visual analogue scale（VAS）and spinal cord functions of each patient were recorded.The ESCC scales were assessed on axial and sagittal T2-weighted MRI images during follow-up.Results PVP combined with ¹²⁵I seed implantation was successfully performed in all 37 patients with 39 MESCC lesions.The mean volume of polymethylmethacrylate（PMMA）injected into each vertebra was 3.2±1.3 ml.The number of ¹²⁵I seeds implanted for each lesion ranged from 10 to 40according to the size of the epidural tumor,and mean radiation dose was 15.0±5.1 m Ci.The preoperative VAS was 8.5±0.8,and the average decrease in VAS was 4.9,4.7,5.1,3.0,and 2.6 at 5days,1 month,3 months,6 months,and 1 year post-procedure,respectively,and these changes were all statistically significant comparing to pre-procedural data.The changes in VAS were not significantly different within the first 3 months after procedure,whereas significant differences were seen when comparing data between 6 months or 1 year post-operation and within 3 months.Among them,22 paralyzed patients experienced spinal cord function improvement at 3 months after operation.The response rate of epidural tumor was 89.7%,91.9%,90.6%,and 94.7%at 1 month,3months,6 months,and 1 year after the procedures,respectively,and it was no significant difference detected within 1-year follow-up.Conclusion Vertebroplasty combined with ¹²⁵I seed brachytherapy was effective and safe for treating spinal metastatic epidural spinal cord compression that provides immediate pain relief and spinal cord function improvement.The regression in grades of ESCC could be reliably assessed and kept stable radiological findings on MRI within 1 year after combined therapy.