A preliminary comparative clinical study of vertebroplasty with multineedle or single-needle interstitial implantation of 125I seeds in the treatment of osteolytic metastatic vertebral tumors

Clinical article

Tao Li M.D., Ph.D. 1 , Jianmin Li M.D., Ph.D. 2 , Zhen Wang M.S. 1 , Baodong Liu M.S. 3 , Dunfu Han M.D., Ph.D. 1 , and Pengyun Wang M.S. 1
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  • 1 Department of Orthopaedic Surgery, Zibo Central Hospital of Binzhou Medical College, Zibo;
  • 2 Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan; and
  • 3 Department of Radiology, Zibo Central Hospital of Binzhou Medical College, Zibo, Shandong, China
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Object

Percutaneous vertebroplasty (PVP) combined with brachytherapy using the interstitial implantation of 125I seeds has previously yielded encouraging clinical results in the treatment of metastatic vertebral tumors. However, the bone cement injection volume is very small due to the osteolytic damage to the metastatic vertebrae, and the ideal spatial distribution of the 125I seeds is difficult to achieve. In the current study, the authors present a clinical method for puncture needle insertion to achieve a greater bone cement injection volume and a more ideal spatial distribution of the 125I seeds.

Methods

Twenty-nine patients with osteolytic metastatic vertebral tumors were divided into 2 groups and were treated with either PVP combined with multineedle interstitial implantation of 125I seeds, or PVP combined with single-needle interstitial implantation of 125I seeds. Clinical efficacy was evaluated according to a visual analog scale (VAS) of pain, the Karnofsky Performance Scale (KPS), and the Response Evaluation Criteria In Solid Tumors (RECIST).

Results

Back pain was significantly alleviated in all patients after surgery. Compared with the preoperative scores, the VAS scores were significantly decreased in both groups at 1 week and 3 months postoperatively (p < 0.05), but there were no significant intergroup differences (p > 0.05). The postoperative quality of life was improved in both groups; the KPS scores increased significantly compared with the preoperative scores (p < 0.05), and the postoperative KPS scores were significantly different between the 2 groups (p < 0.05). No intergroup differences were observed in pain alleviation, but the bone cement injection volume was significantly greater in the multineedle group than in the single-needle group (p < 0.05). The clinical benefit rate and disease control rate at 3 months after the operation were both significantly better for the multineedle group (p < 0.05).

Conclusions

The outcomes of PVP combined with multineedle interstitial implantation of 125I seeds in patients with osteolytic metastatic vertebral tumors appeared to be better than the outcomes of PVP combined with single-needle interstitial implantation of 125I seeds. These better outcomes may be the result of the greater bone cement injection volume and the more ideal spatial distribution of the 125I seeds.

Abbreviations used in this paper:EBRT = external beam radiation therapy; KPS = Karnofsky Performance Scale; PMMA = polymethylmethacrylate; PVP = percutaneous vertebroplasty; RECIST = Response Evaluation Criteria In Solid Tumors; VAS = visual analog scale.

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Contributor Notes

Address correspondence to: Tao Li, M.D., Ph.D., Department of Orthopaedic Surgery, Zibo Central Hospital of Binzhou Medical College, 54 Gongqingtuan Xi Rd., Zibo, Shandong, China 255036. email: litaozhongguo@vip.163.com.

Please include this information when citing this paper: published online February 14, 2014; DOI: 10.3171/2014.1.SPINE13645.

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