Percutaneous Vertebral Augmentation: A Valuable Procedure to Treat Painful, Cancer-Related Spinal Pathology

Cancer pain is a unique creature; to effectively conquer this beast, pain physicians must possess diverse weaponry. The World Health Organization has stipulated guidelines on the treatment of pain; many trained practitioners have widely accepted interventional procedures as the fourth step in the treatment ladder. The authors present a safe, effective, and relatively straightforward interventional procedure in “Percutaneous Vertebral Augmentation in Metastatic Disease: State of the Art” for the alleviation of cancer pain.

A risk–benefit ratio must be considered when using opioid management in the treatment of cancer-related pain, specifically pain caused by vertebral compression fractures. Escalating opioid dose requirements are not without escalating side effects. In actuality, the treating physician must not consider interventional treatment as a “fourth” step in the ladder but as a step that may be first, second, or third, depending on the patient. As the authors rightly identified, many patients do not receive adequate pain relief with medical management. Must all patients, regardless of disease state, be subjected to a minimal 3-week trial period with medication and radiotherapy? Immobility due to compression fractures in already hypercoagulable patients is suboptimal. The cherished goal in cancer-related pain management is improvement in the quality of life. Early intervention for compression fractures via percutaneous kyphoplasty or vertebroplasty seeks that end.

Contraindications for this treatment are fractures that are unstable and involve the posterior margin of the vertebrae or those which compromise the spinal cord. The two proposed mechanisms of pain relief are mechanical stabilization, with or without height restoration, and coagulation of nerve endings in the vertebral body produced by the heat of the cement. In addition, polymethyl methacrylate has a cytotoxic effect on rapidly proliferating cells, and one may argue to expand the indication for prophylactic augmentation of vertebral bodies at risk of fracture in which there is expansive neoplasm present.

In this article, the authors skillfully highlight a relatively low-cost, minimally invasive, low-risk procedure in the alleviation of cancer-related pain. Certainly, more studies are warranted; however, this article contributes to the existing knowledge of physicians who treat cancer-related pain with augmentation, and it works!.

Cancer pain is a unique creature; to effectively conquer this beast, pain physicians must possess diverse weaponry. The World Health Organization has stipulated guidelines on the treatment of pain; many trained practitioners have widely accepted interventional procedures as the fourth step in the treatment ladder. The authors present a safe, effective, and relatively straightforward interventional procedure in “Percutaneous Vertebral Augmentation in Metastatic Disease: State of the Art” for the alleviation of cancer pain.

A risk–benefit ratio must be considered when using opioid management in the treatment of cancer-related pain, specifically pain caused by vertebral compression fractures. Escalating opioid dose requirements are not without escalating side effects. In actuality, the treating physician must not consider interventional treatment as a “fourth” step in the ladder but as a step that may be first, second, or third, depending on the patient. As the authors rightly identified, many patients do not receive adequate pain relief with medical management. Must all patients, regardless of disease state, be subjected to a minimal 3-week trial period with medication and radiotherapy? Immobility due to compression fractures in already hypercoagulable patients is suboptimal. The cherished goal in cancer-related pain management is improvement in the quality of life. Early intervention for compression fractures via percutaneous kyphoplasty or vertebroplasty seeks that end.

Contraindications for this treatment are fractures that are unstable and involve the posterior margin of the vertebrae or those which compromise the spinal cord. The two proposed mechanisms of pain relief are mechanical stabilization, with or without height restoration, and coagulation of nerve endings in the vertebral body produced by the heat of the cement. In addition, polymethyl methacrylate has a cytotoxic effect on rapidly proliferating cells, and one may argue to expand the indication for prophylactic augmentation of vertebral bodies at risk of fracture in which there is expansive neoplasm present.

In this article, the authors skillfully highlight a relatively low-cost, minimally invasive, low-risk procedure in the alleviation of cancer-related pain. Certainly, more studies are warranted; however, this article contributes to the existing knowledge of physicians who treat cancer-related pain with augmentation, and it works!.

Cancer pain is a unique creature; to effectively conquer this beast, pain physicians must possess diverse weaponry. The World Health Organization has stipulated guidelines on the treatment of pain; many trained practitioners have widely accepted interventional procedures as the fourth step in the treatment ladder. The authors present a safe, effective, and relatively straightforward interventional procedure in “Percutaneous Vertebral Augmentation in Metastatic Disease: State of the Art” for the alleviation of cancer pain.

A risk–benefit ratio must be considered when using opioid management in the treatment of cancer-related pain, specifically pain caused by vertebral compression fractures. Escalating opioid dose requirements are not without escalating side effects. In actuality, the treating physician must not consider interventional treatment as a “fourth” step in the ladder but as a step that may be first, second, or third, depending on the patient. As the authors rightly identified, many patients do not receive adequate pain relief with medical management. Must all patients, regardless of disease state, be subjected to a minimal 3-week trial period with medication and radiotherapy? Immobility due to compression fractures in already hypercoagulable patients is suboptimal. The cherished goal in cancer-related pain management is improvement in the quality of life. Early intervention for compression fractures via percutaneous kyphoplasty or vertebroplasty seeks that end.

Contraindications for this treatment are fractures that are unstable and involve the posterior margin of the vertebrae or those which compromise the spinal cord. The two proposed mechanisms of pain relief are mechanical stabilization, with or without height restoration, and coagulation of nerve endings in the vertebral body produced by the heat of the cement. In addition, polymethyl methacrylate has a cytotoxic effect on rapidly proliferating cells, and one may argue to expand the indication for prophylactic augmentation of vertebral bodies at risk of fracture in which there is expansive neoplasm present.

In this article, the authors skillfully highlight a relatively low-cost, minimally invasive, low-risk procedure in the alleviation of cancer-related pain. Certainly, more studies are warranted; however, this article contributes to the existing knowledge of physicians who treat cancer-related pain with augmentation, and it works!.