Speaker Deck
Speaker Deck Pro
Sign in
Sign up
for free
Vertébroplastie et Métastases Vertébrales J.Chiras
journeevertebro
March 23, 2009
0
61
Vertébroplastie et Métastases Vertébrales J.Chiras
16h00-16h40 Vertébroplastie et Métastases Vertébrales J.Chiras
journeevertebro
March 23, 2009
Tweet
Share
More Decks by journeevertebro
See All by journeevertebro
journeevertebro
0
93
journeevertebro
0
110
journeevertebro
0
72
journeevertebro
0
92
journeevertebro
0
85
journeevertebro
0
48
journeevertebro
1
61
journeevertebro
0
60
journeevertebro
0
80
Featured
See All Featured
aarron
258
36k
shpigford
165
19k
carmenhchung
26
1.3k
imathis
478
150k
samlambert
237
9.9k
zakiwarfel
88
3.3k
bryan
100
11k
addyosmani
1348
190k
yeseniaperezcruz
302
31k
jacobian
255
20k
malarkey
119
16k
geeforr
332
29k
Transcript
J. CHIRAS, H. BARRAGAN CAMPOS,E. CORMIER, B. JEAN, M. ROSE
Department of Neuroradiology - GH PITIE-SALPETRIERE Paris - France PERCUTANEOUS VERTEBROPLASTY for SPINE METASTASES
VERTEBROPLASTY - percutaneous injection - surgical cement - fluoroscopic control
Goal antalgic effet spine stabilisation complementary TT alternative TT
LOCAL TT for BONE METASTASES K SURGERY CHEMOEMBOLIZATION RTH CEMENTOPLASTY
Local TT for Bone Metastase
indications • painfull and/or unstable metastases of the vertebral body
C2 S2 • Lytic and sclerotic metastases • ( asymptomatic metastases )
osteosclerotic metastases
osteosclerotic metastases
• Clinical : - neurological deficit - predominent radicular pain
- infection local or systemic - aplasia ( temporary ) • Radiological : - main epiduritis - predominent posterior arch metastase CONTRA INDICATIONS CHEMO CHEMO V°
• Clinical : - neurological deficit - predominent radicular pain
- infection local or systemic - aplasia ( temporary ) • Radiological : - main epiduritis - predominent posterior arch metastase CONTRA INDICATIONS CHEMO CHEMO V°
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 )
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
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
recurrent pain after local treatment ( breast K )
recurrent pain after local treatment ( breast K )
None
malignant pheochromocytoma
malignant pheochromocytoma
Initial treatment of vertebral metastases • point of therapeutic decision
- radio / chemo sensitivity - spine instability • Combined local TT : RF ablation RTH Surgery Chemoembolization
None
None
F. 31 y, breast K. , …
F. 31 y, breast K. , …
1 year later…
1 year later…
Osteosclerotic metastases prostat K.
Osteosclerotic metastases prostat K.
Association Rth and vertebroplasty (First)
Association Rth and vertebroplasty (First)
Breast K.
Breast K.
Vertebroplasty + Surg. ± Rth renal carcinoma
Vertebroplasty + Surg. ± Rth renal carcinoma
None
None
None
None
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
LONGTERM RESULTS NO RECURRENCE AT 5 YEARS FOLLOW UP NO
RECURRENCE AT 4 YEARS FOLLOW UP ( breast k. ) ( m. pheo )
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 )
Local complications/ Technical problems extra-vertebral leak: - veins - soft
tissues mecanism: - fluid cement - hyper pressure - needle position
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
Osteoclerotic metastases - clinical improvement : 90 % - complications
: 10 % ( radicular pain PULM - EMB )
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
METHOD - 59 procedures - 103 vertebrae ( C: 2
- Th: 59 - L: 42 )
INDICATION ( 103 vertebrae ) • primary local TT 66V
• local recurrence 37V THERAPEUTIC PROTOCOL • VERT 92 • VERT + RTH 6 • VERT + SURG 6
TECHNICAL PROBLEMS - HARDNESS OF THE VERTEBRA Difficulties for needle
position - DENSITY OF THE BONE High pressure injection ⇑ the risk of leakage. HETEROGENEOUS FILLING
RESULTS ANATOMICAL RESULT CLINICAL RESULT
ANATOMICAL RESULT (FILLING) - 103 V - • FAILURE 8%
• POOR 25% • MODERATE 20% • ADEQUATE 55% •LEAKAGE 50,5%
None
None
None
None
None
None
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
Clinical results • antalgic effect : - immediate (< 3
days) - clear 22 % - partial 60 % • prolonged reinforcement 95 % of cases
Clinical results • antalgic effect : - immediate (< 3
days) - clear 22 % - partial 60 % • prolonged reinforcement 95 % of cases
CONCLUSIONS • Low rate of definitive complications (0.7%) • High
rate of pain release (70 → 90%) • Potential carcinolytic effect ⇒ INDICATIONS
CONCLUSIONS • Low rate of definitive complications (0.7%) • High
rate of pain release (70 → 90%) • Potential carcinolytic effect ⇒ INDICATIONS
Department of Neuroradiology - GH PITIE-SALPETRIERE Paris - France