Treatment of Bone Metastases with Symptomatic Vertebral Body Fractures in the Absence of Epidural Disease
This protocol addresses a specific subset of patients with bone metastases who present with symptomatic vertebral body fractures, where there is no epidural disease involvement and no retropulsion of bone fragments into the spinal cord.
Clinical Scenario
- Symptomatic vertebral body fractures secondary to bone metastases
- Absence of epidural disease
- Absence of retropulsion of bone fragments into the spinal cord
Treatment Approach (Overview)
Management involves a minimally invasive vertebral stabilisation procedure — either vertebroplasty or kyphoplasty — used alongside external beam radiotherapy. These procedures are specifically reserved for patients meeting the eligibility criteria above.
The complete regimen, sequencing, and clinical decision pathway are available in the full structured protocol.
References
DOI: 10.1007/s12094-016-1590-1
- Vertebroplasty and Kyphoplasty are reserved for patients with symptomatic vertebral body fractures without epidural disease or retropulsion of bone fragments into the spinal cord.
- Although clinical experience is limited, ASTRO guidelines recommend that radiotherapy be used in conjunction with these procedures.
- Kyphoplasty and vertebroplasty may be useful for the treatment of lytic osteoclastic spine metastases or in cases of spinal instability, where surgery is not feasible or indicated; they do not obviate the need for external beam RT.
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