Mesh-Container Plasty in advanced painful osteolytic vertebral metastases with posterior wall defect：a retrospective observational study

Abstract

Abstract Background： Percutaneous vertebroplasty for deficient posterior wall of metastatic vertebrae lead to high rate of bone cement leakage. In order to improve the safety, MCP, a new technique improved based on PVP, has been developed to control the dispersion of bone cement. Objective: To evaluate the efficacy and safety of Mesh-Container Plasty (MCP) in patients suffering advanced vertebral metastases with deficient posterior wall. Patients and methods: 111 patients were retrospectively included from January 2014 to January 2018 in our hospital. These patients were divided into two groups, group MCP (n=51) and group PVP (n=60). According to the percentage of the area of posterior wall defect as the total area of posterior wall, the patients of both groups were originally classified into four grades, grade I≤25%, grade II 26%-50%, grade III 51%-75%, grade IV 76%-100%. Visual analog scale (VAS) and Oswestry disability index (ODI) were applied to compare the efficacy before and after MCP and PVP. Minor and major complications were systematically recorded to measure the safety. Results： Both groups experienced significant pain relief and improvement of motor function after MCP and PVP. Pre-op and post-op VAS and ODI at any time point during follow-up did not present significant difference between MCP and PVP (P > 0.05). In MCP, 13 cases presented bone cement leakage, with the leakage rate of 25.49%. None of the patients developed any clinical or neurological symptoms. In PVP, 50% of the patients occurred bone cement leakage. Six patients developed neurological symptoms. major complications between two groups presented significant difference for bone cement leakage (P=0.03). Conclusion: In conclusion, MCP is able to significantly relieve pain and improve the safety in treating vertebral metastases with deficient posterior wall. It provides a better option for spinal surgeon to treat vertebral metastases with posterior wall deficiency.