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Vertébroplastie et Métastases Vertébrales J.Chiras

journeevertebro
March 23, 2009
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Vertébroplastie et Métastases Vertébrales J.Chiras

16h00-16h40 Vertébroplastie et Métastases Vertébrales J.Chiras

journeevertebro

March 23, 2009
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  1. J. CHIRAS, H. BARRAGAN CAMPOS,E. CORMIER, B. JEAN, M. ROSE

    Department of Neuroradiology - GH PITIE-SALPETRIERE Paris - France PERCUTANEOUS VERTEBROPLASTY for SPINE METASTASES
  2. indications • painfull and/or unstable metastases of the vertebral body

    C2 S2 • Lytic and sclerotic metastases • ( asymptomatic metastases )
  3. • Clinical : - neurological deficit - predominent radicular pain

    - infection local or systemic - aplasia ( temporary ) • Radiological : - main epiduritis - predominent posterior arch metastase CONTRA INDICATIONS CHEMO CHEMO V°
  4. • Clinical : - neurological deficit - predominent radicular pain

    - infection local or systemic - aplasia ( temporary ) • Radiological : - main epiduritis - predominent posterior arch metastase CONTRA INDICATIONS CHEMO CHEMO V°
  5. INDICATIONS vertebroplasty/other local treatments • recurrence of pain after radiotherapy

    • first step of local treatment for pain relief or spine stabilization ( in association with general TT ) • multidisciplinary group ( oncologist, radiotherapist, spinsurgeon, interventional neuroradiologist )
  6. MATERIAL - 803 patients - 982 vertebroplasties - 2168 vertebrae:

    cervical 221 thoracic 1093 lumbar 835 sacrum 19 Primary N % breast 348 43,3 lung 96 12,0 Thyroid 64 6,7 kidney 54 6,6 unknown 49 6,1 Prostat 33 4,1 other 170 21,2 TOTAL 603 100,0
  7. therapeutic protocol • PAIN RECURRENCE 397 cases (after local treatment)

    • INITIAL TREATMENT 585 cases - vert 191 cases - vert + Rth 253 cases - vert + surg. ± Rth 56 cases - vert + surg. 85 cases
  8. Initial treatment of vertebral metastases • point of therapeutic decision

    - radio / chemo sensitivity - spine instability • Combined local TT : RF ablation RTH Surgery Chemoembolization
  9. RESULTS 803 patients 1° ANTALGIC EFFECT (relief of pain) 731

    91% - clear or complete 177 22% - partial 554 69% - poor 72 9% 2°CARCINOLYTIC EFFECT no local recurrence 90% of cases
  10. LONGTERM RESULTS NO RECURRENCE AT 5 YEARS FOLLOW UP NO

    RECURRENCE AT 4 YEARS FOLLOW UP ( breast k. ) ( m. pheo )
  11. Complications • Local (1,6%) - hematomas 1 cervical requiring intubation

    - radicular pain 14 all resolutive after TT ( 8 NSAIDs TT - 5 FORAMINAL BLOCKAGE, 1 surgical debulking ) - paraplegia non resolutive despite surgical TT 1 • General (0,7%) Major complications: 1° cervical vert. :arterial migration fatal stroke ( 0,4% ) 2° thoracic vert. :cord compression paraplegia ( 0,1% ) ( during last 4 years no major complication )
  12. Local complications/ Technical problems extra-vertebral leak: - veins - soft

    tissues mecanism: - fluid cement - hyper pressure - needle position
  13. Complications/posterior wall disruption (R=1) (2168 vertebrae) Radicular pain Paraplegia R=1

    N=1068 7 R=0 N=1100 7 1 N=2168 14 (7% ) 1 (0,5% ) 0  
  14. MATERIAL • 52 patients - M 6 - F 46

    Age : 27 - 84 Y ( M = 54,7 ) •Primary cancer: - Breast 4 - Prostate 3 - Other 9 • CT evaluation: pure osteoclerotic 53 mixed sclerotic / lytic 50
  15. INDICATION ( 103 vertebrae ) • primary local TT 66V

    • local recurrence 37V THERAPEUTIC PROTOCOL • VERT 92 • VERT + RTH 6 • VERT + SURG 6
  16. TECHNICAL PROBLEMS - HARDNESS OF THE VERTEBRA Difficulties for needle

    position - DENSITY OF THE BONE High pressure injection ⇑ the risk of leakage. HETEROGENEOUS FILLING
  17. ANATOMICAL RESULT (FILLING) - 103 V - • FAILURE 8%

    • POOR 25% • MODERATE 20% • ADEQUATE 55% •LEAKAGE 50,5%
  18. CLINICAL RESULTS ( 1M ) - PAIN RELEASE COMPLETE 71%

    - PAIN RELEASE PARTIAL 21% COMPLICATIONS ( POST-OP ) 11,9% • LOCAL: - RADICULALGIE 3 ( TRANSCIENT 1 PERSISTENT 2 ï LOCAL TT) - CAUDAEQUINA SYNDROM 1 ( EPIDURITIS ) - HEMOTHORAX 1 • GENERAL : PULMONARY EMBOLISM 2
  19. Clinical results • antalgic effect : - immediate (< 3

    days) - clear 22 % - partial 60 % • prolonged reinforcement 95 % of cases
  20. Clinical results • antalgic effect : - immediate (< 3

    days) - clear 22 % - partial 60 % • prolonged reinforcement 95 % of cases
  21. CONCLUSIONS • Low rate of definitive complications (0.7%) • High

    rate of pain release (70 → 90%) • Potential carcinolytic effect ⇒  INDICATIONS
  22. CONCLUSIONS • Low rate of definitive complications (0.7%) • High

    rate of pain release (70 → 90%) • Potential carcinolytic effect ⇒  INDICATIONS