Treatment of Neoplastic Vertebral Compression Fractures with Device-assisted Kyphoplasty: A Case-series and Systematic Review

Introduction: Vertebroplasty and Balloon-assisted Kyphoplasty (BKP) have traditionally been used to achieve symptomatic relief for painful osteoporotic vertebral fractures. However, there is a lack of consensus on the optimal indications and techniques for vertebral augmentation with Spinejack (SJ) in metastatic disease. This study aims to evaluate the effectiveness of Spinejack in improving quality of life and report the clinical outcomes. Establishing guidelines for the use of SJ in managing spinal metastases is crucial for identifying appropriate cases and optimizing treatment outcomes.

Methods: We conducted a single institution retrospective review up to January 2023 of patients with spinal metastases and MM who underwent kyphoplasty with SJ and collected information regarding perioperative pain, radiographic features, and complication rates. Additionally, we included a systematic review under PRISMA guidelines comparing SJ and BKP in spinal metastasis patients. Outcomes regarding pain scores (Visual Analogue Scale, VAS), vertebral height gain, and kyphotic angle were assessed

Results: A total of 17 patients were collected with 42 devices implanted. Clear Cell Renal Cell Carcinoma (RCC) was the most common primary tumor diagnosis. An absolute pain reduction sustained for up to 6 months and a vertebral height increase maintained for one year was documented. In our systematic review, a total of 602 patients were analyzed. No differences were found regarding demographic features. Postoperative pain VAS at 6 months was lower in the SJ group (p < 0.01). Cobb angles were significantly minor in the SJ group (p = 0.01). However, a high heterogeneity was found between the SJ studies. SJ provided a significantly greater height gain in the 60 to 70-year-old age group (up to 4.1mm) than BKP (0.4mm).

Conclusion : SJ is a promising option for pathologic fractures secondary to neoplastic infiltration in adequately selected cases. The SJ studies included have a highly heterogeneous indication criterion. Establishing guidelines for using SJ in managing spinal metastases is crucial for identifying appropriate cases and optimizing treatment outcomes. Prospective studies with longer follow-ups are required to assess long-term outcomes.