Palliation of compression fractures in cancer patients by vertebral augmentation: a retrospective analysis

Aim To evaluate the efficacy of vertebral augmentation (VA) in cancer patients. Materials and methods From a retrospectively compiled database, 147 cancer cases (236 levels) were treated with VA. Mean age was 71+/-12 years and 56.5% were female. Variables evaluated include age, sex, procedure type, vertebral level treated, number of levels treated per procedure and technical approach. Outcomes were assessed by a previously described method retrospectively applied from medical records: a binary system of 'responders' versus 'non-responders' and further subcategorization with a four level pain scale. Two patient groups were analyzed: (1) 147 cancer patients with either osteoporotic or malignant vertebral compression fractures (all compression fractures (ACFs)) and (2) 102 cases with documented metastatic compression fractures (MCFs). Univariate and multivariate analyses determined outcomes. Results 93% of MCFs and 88.5% of ACFs showed response to treatment (pain improvement or resolution): 30% of ACFs and 31% of MCFs experienced pain resolution. MCFs showed increasing age to be a predictor of response to treatment in univariate (OR = 1.79, p = 0.04) and multivariate (OR = 2.05, p = 0.03) analysis. In ACFs, bipedicular needle approach decreased the odds of pain resolution (OR = 0.28, p = 0.01). In MCFs, lung cancer (OR = 0.06, p = 0.03) and multiple myeloma (OR = 0.10, p = 0.01) decreased the odds of pain resolution. Conclusions VA provides pain relief for a majority of ACFs and MCFs. Increasing age may be predictive of pain relief outcomes in MCFs. There are special planning, imaging and technical considerations (eg, needle placement) in using VA to treat cancer patients.