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  • Kyphoplasty with silicone purified VK100 (Elastoplasty) for the treatment of spinal lytic lesions in cancer patients: a retrospective evaluation of 46 cases.

    Final Number:
    2042

    Authors:
    Alfredo Pompili MD; Laura Raus; Francesco Crispo; Maddalena Giovannetti MD; Carmine Carapella; Stefano Telera MD; Isabella Sperduti; Fabrizio Caroli

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting - Late Breaking Science

    Introduction: Balloon Kyphoplasty (BKP) for vertebral compression fractures (VCFs) in cancer patients is more challenging than for osteoporotic ones. Cord compressions are frequent and the incidence of cement intracanalar and vascular leakages is ten-fold greater. PMMA is the gold standard for BKP. However, PMMA has some disadvantages: exothermic reaction, short working time, rapid solidification, absence of osteoconductive properties.

    Methods: VK100 is a mixture of Dimethyl methylvinyl siloxane, Barium Sulphate and Platinum catalyst. It is adhesive to bone, it has no exothermic reaction leaving up to 30 minutes before solidification and is more elastic. The surgical procedure required is a standard kyphoplasty. We treated 46 cancer patients (80 vertebral bodies) with VK100, through percutaneous BKP, open BKP and augmentation procedures to implement thoraco-lumbar stabilizations. Leakages and pulmonary embolism (PE) were evaluated with CT scans. Median follow-up was 14 months.

    Results: The average working time allowed by VK 100 was 30 minutes. The mean volume of silicon inserted in each vertebra was 3.8 cc. Complications included seven cases of leakages in 41 patients treated with BKP (17%), two asymptomatic pulmonary embolism (PE) (4.3%) and 3 postoperative adjacent fractures (7.3%). A significant improvement was observed in KPS, VAS and Dennis Pain Score (p < 0.0001). The 1-yr survival rate was 77.5%.

    Conclusions: Kyphoplasty with siliconic material VK100 (Elastoplasty) appears a safe and effective palliative treatment of VCFs in oncologic patients. Major advantages over PMMA are the lack of exothermic reaction and the wider working window. The influence of biomechanical properties of silicone on reduction of adjacent level fractures requires further investigations.

    Patient Care: A new material for Kyphoplasty may improve the results that can be obtained with traditional PMMA by limiting the complications.

    Learning Objectives: Partecipants should be aware of the palliative tratments in vertebral fractures in cancer patients, they should know the open and percutaneous Kyphoplasty techniques and should be able to evaluate the different materials that can be used for this purpose.

    References:

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