Container Plasty in Advanced Painful Osteolytic Vertebral Metastases With Posterior Wall Defect: A Retrospective Observational Study.

Abstract

Study design: Review of mesh-container plasty (MCP) in osteolytic vertebral metastases.

Objective: This study aims to assess the efficacy and safety of MCP in treating advanced vertebral metastases with posterior wall defects.

Background: Diagnosis of vertebral metastases typically relies on the patient's tumor history, bone scans, or vertebral MRI. Surgical intervention often involves sampling vertebral body tissue for pathologic diagnosis. The revised Tokuhashi score is commonly used to predict survival time in patients with bone metastases. Outcome evaluation frequently employs the visual analog scale (VAS) and the Oswestry disability index (ODI) in assessing spinal surgery outcomes.

Methods: A retrospective analysis included 111 patients treated between January 2014 and January 2018 in our hospital. Patients were categorized into 2 groups: MCP group (n=51) and PVP group (n=60). Grades based on the percentage of posterior wall defect area were established: grade I (≤25%), grade II (26% to 50%), grade III (51% to 75%), and grade IV (76% to 100%). Efficacy was assessed using VAS and ODI.

Results: Both MCP and PVP groups exhibited significant pain relief and improved motor function. No significant differences were observed in VAS and ODI scores at any follow-up point ( P >0.05). In the MCP group, bone cement leakage occurred in 13 cases, with a leakage rate of 25.49%. However, none of the patients experienced clinical or neurological symptoms. In the PVP group, bone cement leakage occurred in 50% of patients, with 6 patients developing neurological symptoms. Significant differences between the groups were observed in major complications related to bone cement leakage ( P =0.03).

Conclusion: MCP demonstrates efficacy in pain relief and safety in treating vertebral metastases with deficient posterior walls. It represents a promising option for spinal surgeons managing vertebral metastases with posterior wall deficiencies.