Ont Health Technol Assess Ser. 2016 May 1;16(11):1-202. eCollection 2016.
Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies, including bed rest, bracing, and analgesic use, can be ineffective, resulting in continued pain and progressive functional disability limiting mobility and self-care. Surgery is not usually an option for cancer patients in advanced disease states because of their poor medical health or functional status and limited life expectancy. The objectives of this review were to evaluate the effectiveness and safety of percutaneous image-guided vertebral augmentation techniques, vertebroplasty and kyphoplasty, for palliation of cancer-related vertebral compression fractures.
We performed a systematic literature search for studies on vertebral augmentation of cancer-related vertebral compression fractures published from January 1, 2000, to October 2014; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. Owing to the heterogeneity of the clinical reports, we performed a narrative synthesis based on an analytical framework constructed for the type of cancer-related vertebral fractures and the diversity of the vertebral augmentation interventions.
The evidence review identified 3,391 citations, of which 111 clinical reports (4,235 patients) evaluated the effectiveness of vertebroplasty (78 reports, 2,545 patients) or kyphoplasty (33 reports, 1,690 patients) for patients with mixed primary spinal metastatic cancers, multiple myeloma, or hemangiomas. Overall the mean pain intensity scores often reported within 48 hours of vertebral augmentation (kyphoplasty or vertebroplasty), were significantly reduced. Analgesic use, although variably reported, usually involved parallel decreases, particularly in opioids, and mean pain-related disability scores were also significantly improved. In a randomized controlled trial comparing kyphoplasty with usual care, improvements in pain scores, pain-related disability, and health-related quality of life were significantly better in the kyphoplasty group than in the usual care group. Bone cement leakage, mostly asymptomatic, was commonly reported after vertebroplasty and kyphoplasty. Major adverse events, however, were uncommon.
Both vertebroplasty and kyphoplasty significantly and rapidly reduced pain intensity in cancer patients with vertebral compression fractures. The procedures also significantly decreased the need for opioid pain medication, and functional disabilities related to back and neck pain. Pain palliative improvements and low complication rates were consistent across the various cancer populations and vertebral fractures that were investigated.
转移至脊柱的癌症以及诸如多发性骨髓瘤等原发性癌症可导致椎体压缩骨折或椎体不稳。包括卧床休息、支具固定及使用镇痛药在内的保守治疗策略可能无效，从而导致持续疼痛和功能逐渐丧失，限制了活动能力和自我护理能力。对于处于疾病晚期的癌症患者，由于其健康状况或功能状态较差且预期寿命有限，手术通常并非可行选择。本综述的目的是评估经皮影像引导下椎体强化技术（椎体成形术和后凸成形术）缓解癌症相关椎体压缩骨折的有效性和安全性。
我们对2000年1月1日至2014年10月发表的有关癌症相关椎体压缩骨折椎体强化的研究进行了系统的文献检索；由一名审阅者筛选摘要。对于符合纳入标准的研究，获取全文。由于临床报告的异质性，我们基于为癌症相关椎体骨折类型及椎体强化干预措施的多样性构建的分析框架进行了叙述性综合分析。
证据检索共识别出3391条引文，其中111篇临床报告（4235例患者）评估了椎体成形术（78篇报告，2545例患者）或后凸成形术（33篇报告，1690例患者）对混合性原发性脊柱转移癌、多发性骨髓瘤或血管瘤患者的有效性。总体而言，椎体强化（后凸成形术或椎体成形术）后48小时内常报告的平均疼痛强度评分显著降低。镇痛药的使用虽报告不一，但通常呈平行下降，尤其是阿片类药物，且平均疼痛相关功能丧失评分也显著改善。在一项比较后凸成形术与常规治疗的随机对照试验中，后凸成形术组在疼痛评分、疼痛相关功能丧失及健康相关生活质量方面的改善显著优于常规治疗组。椎体成形术和后凸成形术后常见骨水泥渗漏，大多无症状。然而，严重不良事件并不常见。
椎体成形术和后凸成形术均能显著且迅速降低癌症相关椎体压缩骨折患者的疼痛强度。这些手术还显著减少了阿片类镇痛药的使用需求以及与背部和颈部疼痛相关的功能丧失。在所研究的各种癌症人群和椎体骨折中，疼痛缓解改善及低并发症发生率是一致的。
