RT is reserved for metastatic spinal disease and typically for those spinal metastases causing pain, neurologic compromise, or those asymptomatic lesions with radiologic features suggesting a risk of neurologic compromise or VCF. Systemic Radionuclide Therapy This procedure is not useful for this clinical scenario but this therapy maybe an option for pain palliation in patients with multifocal osteoblastic metastases, particularly hormone-resistant prostate and breast cancers. The radionuclides are incorporated into the bony matrix and emit radioactive alpha or beta particles that reduce tumor volume and decrease the production of pain sensitive cytokines Variant 9: Pathological VCF with ongoing or increasing mechanical pain. Initial treatment. Medical Management Only Medical management is complementary to other therapies and should be offered in all clinical scenarios. Upon presentation with neurological deficits, the patient should be treated with corticosteroid therapy, and treatment should be initiated as soon as possible to prevent further neurological deterioration [142]. Percutaneous Ablation Spine Image-guided ablative therapies demonstrate potential advantages, including reduced morbidity, lower procedural suitability for real-time imaging guidance, the ability to perform therapy in an outpatient setting, synergy with other cancer treatments, repeatability, and short procedural time [143]. Percutaneous thermal ablation of vertebral metastases is a valid therapeutic option for the following patient subgroups: patients with a life expectancy of more than 6 months, good performance status, and few visceral metastases; uncomplicated (lack of metastatic epidural spinal cord compression), painful spinal metastases; and stable pathologic VCF. Percutaneous thermal ablation has been demonstrated to be an effective treatment option for the management of vertebral metastases with an excellent safety profile.
Management of Vertebral Compression Fractures PCAs. RT is reserved for metastatic spinal disease and typically for those spinal metastases causing pain, neurologic compromise, or those asymptomatic lesions with radiologic features suggesting a risk of neurologic compromise or VCF. Systemic Radionuclide Therapy This procedure is not useful for this clinical scenario but this therapy maybe an option for pain palliation in patients with multifocal osteoblastic metastases, particularly hormone-resistant prostate and breast cancers. The radionuclides are incorporated into the bony matrix and emit radioactive alpha or beta particles that reduce tumor volume and decrease the production of pain sensitive cytokines Variant 9: Pathological VCF with ongoing or increasing mechanical pain. Initial treatment. Medical Management Only Medical management is complementary to other therapies and should be offered in all clinical scenarios. Upon presentation with neurological deficits, the patient should be treated with corticosteroid therapy, and treatment should be initiated as soon as possible to prevent further neurological deterioration [142]. Percutaneous Ablation Spine Image-guided ablative therapies demonstrate potential advantages, including reduced morbidity, lower procedural suitability for real-time imaging guidance, the ability to perform therapy in an outpatient setting, synergy with other cancer treatments, repeatability, and short procedural time [143]. Percutaneous thermal ablation of vertebral metastases is a valid therapeutic option for the following patient subgroups: patients with a life expectancy of more than 6 months, good performance status, and few visceral metastases; uncomplicated (lack of metastatic epidural spinal cord compression), painful spinal metastases; and stable pathologic VCF. Percutaneous thermal ablation has been demonstrated to be an effective treatment option for the management of vertebral metastases with an excellent safety profile.