Therapeutic Effect of Bone-Filling Mesh Container in Treating Vertebral Metastases with Vertebral Body Posterior Marginal Damage

Background: In order to reduce the occurrence of bone cement leakage, bone filling mesh container technique can be a prior choice for the treatment of vertebral metastases with damaged posterior margin of the thoracolumbar vertebral body. Objectives: The purpose of this retrospective study was to compare the efficacy and safety of percutaneous balloon kyphoplasty (PKP) and bone filling mesh containers (BFMCS) in the treatment of vertebral metastases with posterior vertebral body damage. Patients and Methods: This is a retrospective study. From October 2016 to January 2018, 40 cases (72 vertebral bodies) of thoracolumbar osteolytic metastases were treated with vertebroplasty. Among them, 20 cases (37 vertebral bodies) were treated with PKP (PKP group), and 20 cases (35 vertebral bodies) were treated with BFMCS (BFMCS group). The operation time of the two groups was recorded, and visual analog scale (VAS), Oswestry disability index (ODI), intraoperative bone cement leakage and complications were observed before operation and 1 day, 1 month and 6 months after operation. Results: All patients underwent successful operation. The operation time of the PKP group was 42.65 +/- 7.84 minutes, and 42.95 +/- 8.48 minutes in the BFMCS group (P = 0.91). Both groups differed significantly when the results were compared with those measured before treatment. VAS dropped from 7.50 +/- 0.95 points before operation to 1.20 +/- 0.41 points at 6 months follow up in PKP group (P < 0.001), in the BFMCS group VAS dropped from 7.50 +/- 0.94 points before operation to 1.45 +/- 0.51 points at 6 months after operation (P < 0.001). The ODI of the PKP group dropped from 75.80 +/- 4.76 before operation to 12.05 +/- 1.47, 6 months after operation (P < 0.001), ODI dropped from 75.00 +/- 4.34 before operation to 11.60 +/- 1.39 at 6 months followup in the BFMCS group (P < 0.001). In the PKP group, 15 vertebral bodies (40.5%,15/37) occurred bone cement leakage, but the patients had no clinical symptoms of bone cement leakage. Cement leakage occurred in one case in the BFMCS group. There were no complications such as pulmonary embolism, paraplegia or perioperative death. Conclusion: The application of bone-filling mesh container for treating patients with thoracolumbar osseointegrated metastases could significantly reduce the leakage rate of bone cement, and is similar to traditional PKP in pain relief and activity improvement.