CT-guided percutaneous vertebroplasty combined with ¹²⁵I-seed implantation for metastatic vertebral carcinoma involving the spinal canal: analysis of 23 cases

Objective: To evaluate the safety and efficacy of CT-guided percutaneous vertebroplasty (PVP) combined with ¹²⁵I-seed implantation for the treatment of metastatic vertebral carcinoma involving the spinal canal. Methods: A total of 28 involved vertebrae were detected in 23 patients with metastatic vertebral carcinoma. Each patient had 1-2 diseased vertebrae. The lesions included cervical vertebra (n=4), thoracic vertebra (n=13) and lumbar vertebra (n=11). Destroyed posterior vertebral wall was seen in all involved vertebrae. Thirteen vertebrae found in 12 patients showed involvement of the epidural space. According to treatment planning system (TPS) CT-guided implantation of ¹²⁵I seeds was carried out first for cervical lesions, which was followed by PVP. For the thoracic and lumbar lesions, unilateral or bilateral puncturing with several particle needles was employed to implant the ¹²⁵I seeds, then, PVP with bone cement injection was performed. The complications and the clinical efficacy were analyzed. Results: Successful operation was obtained in all patients. The number of implanted ¹²⁵I seeds ranged from 4 to 30 per vertebra, and the volume of injected bone cement was 1-6 ml per vertebra. After the operation the pain relief rate was 86.9% (n=20). The incidence of bone cement leakage was 17.8% (5/28). One patient had radicular pain caused by neuropore leakage, which was relieved after medication. No serious complications, such as spinal cord injury or radiation myelitis, occurred. Conclusion: CT-guided PVP combined with ¹²⁵I-seed implantation is effective and safe for the treatment of metastatic vertebral carcinoma involving the spinal canal. This therapy can effectively relieve the pain and control the deterioration of tumor, besides, the incidence of bone cement leakage is very low. (authors)