This is a systematic review of vertebroplasty and kyphoplasty for cancer-related vertebral compression fractures from spinal metastases, multiple myeloma, or hemangiomas. It asks whether these percutaneous cement augmentation techniques safely and effectively palliate pain, cut opioid use, and improve function in patients too frail for open surgery. The review synthesized 111 clinical reports covering 4,235 patients.
When a cancer patient with a painful vertebral compression fracture cannot ambulate or tolerate physical therapy despite 24 hours of analgesics, vertebral augmentation is a reasonable next step, not open surgery.
Many of these patients are poor surgical candidates because of frailty and short life expectancy, and radiotherapy relieves pain slowly and does nothing for mechanical instability. Cement augmentation addresses the mechanical problem directly, which is why pain relief comes within 24 to 48 hours.
Weigh the evidence honestly. The pain and disability improvements are large and consistent, but rest mostly on observational data. Only one RCT (kyphoplasty vs usual care) provides controlled comparison.
Counsel patients that cement leakage is common but usually asymptomatic, and serious complications are rare. The practical payoff a resident should track is opioid reduction, which preserves alertness and interaction with family in the palliative setting.
This is a systematic review of vertebroplasty and kyphoplasty for cancer-related vertebral compression fractures from spinal metastases, multiple myeloma, or hemangiomas. It asks whether these percutaneous cement augmentation techniques safely and effectively palliate pain, cut opioid use, and improve function in patients too frail for open surgery. The review synthesized 111 clinical reports covering 4,235 patients.
When a cancer patient with a painful vertebral compression fracture cannot ambulate or tolerate physical therapy despite 24 hours of analgesics, vertebral augmentation is a reasonable next step, not open surgery.
Many of these patients are poor surgical candidates because of frailty and short life expectancy, and radiotherapy relieves pain slowly and does nothing for mechanical instability. Cement augmentation addresses the mechanical problem directly, which is why pain relief comes within 24 to 48 hours.
Weigh the evidence honestly. The pain and disability improvements are large and consistent, but rest mostly on observational data. Only one RCT (kyphoplasty vs usual care) provides controlled comparison.
Counsel patients that cement leakage is common but usually asymptomatic, and serious complications are rare. The practical payoff a resident should track is opioid reduction, which preserves alertness and interaction with family in the palliative setting.