Identification of prognostic factors and optimization of preventive vertebroplasty
Project objectives
The vertebral column is the most frequent localization site of skeletal metastases. Approximately one-third of all cancer patients develop vertebral metastases (1). The optimization of oncological treatment has led to an increase in life expectancy and, consequently, the increase in survival has led to an increase in the incidence of metastases (2). The goal of medical care has therefore shifted to improving the quality of life. Vertebral fractures following metastases cause pain, deformity, loss of mobility and possible neurological complications that significantly affect quality of life (3-5). Therefore, it is important to be able to adequately evaluate a metastatic vertebral lesion in order to prevent the onset of fractures (6). In this regard, the concept of "Impending Fracture” in reference to a pathological condition that weakens the bone segment to the point that it risks fracturing under physiological loads (7). However, to date, there are no guidelines for the management of patients with vertebral metastases at risk of fracture, nor objective methods for selecting patients who could benefit from preventive treatment (5).
The general objective of the project is to describe the effects of factors potentially relevant to the risk of metastatic lumbar spine fracture. Specifically, this study aims to define the fracture risk according to:
- the location of the tumor lesion in the vertebral body (anterior, posterior, superior, inferior, lateral)
- the involvement of the pedicles and the bone cortex,
- the presence of multiple metastases in the same vertebral body and on multiple vertebrae,
- the size and type of load applied.
Furthermore, in order to obtain more detailed information about the efficacy and potential risks of vertebroplasty performed for preventive purposes, different types of cement available on the market will be compared. This evaluation will allow to identify the cement with the best mechanical properties, able to stabilize the vertebral body without altering the distribution of loads, thus reducing the risk of fracture of the adjacent levels.
Start and end date
2019 - 2021
Project managers
Prof. Vincenzo Denaro - Coordinator
Prof. Umile Giuseppe Longo
Prof. Rocco Papalia
Coordinating institution of the project
Università Campus Bio-Medico di Roma
Other institutions involved in the project
Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester (MN) – USA
References
- Aaron AD. The management of cancer metastatic to bone. JAMA: the journal of the American Medical Association. 1994;272(15):1206-9.
- Ohmori K, Matsui H, Yasuda T, Kanamori M, Yudoh K, Seto H, et al. Evaluation of the prognosis of cancer patients with metastatic bone tumors based on serial bone scintigrams. Jpn J Clin Oncol. 1997;27(4):263-7.
- Hortobagyi GN, Theriault RL, Lipton A, Porter L, Blayney D, Sinoff C, et al. Long-term prevention of skeletal complications of metastatic breast cancer with pamidronate. Protocol 19 Aredia Breast
- Cancer Study Group. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 1998;16(6):2038-44.
- Hortobagyi GN. The status of breast cancer management: challenges and opportunities. Breast Cancer Res Treat. 2002;75 Supplement 1:S61-5; discussion S57-9.
- Hipp JA, Springfield DS, Hayes WC. Predicting pathological fracture risk in the management of metastatic bone defects. Clinical orthopedics and related research. 1995(312):120-35.
- Eastley N, Newey M, Ashford RU. Skeletal metastases - the role of the orthopedic and spinal surgeon. Surgical oncology. 2012;21(3):216-22.
- Piccioli A, Biagini R, Brach del Prever E, Capanna R, Denaro V, Fazioli F, et al. SIOT paper on the treatment of bone metastases. Review of SIOT guidelines on vertebral metastases; XXXVIII(5):[176-93 pp.].
