Multi-level Percutaneous Vertebroplasty for Multiple Spinal Metastases With Asymptomatic Epidural Compression: A Case-Based Example of Minimally Invasive Patient Management

Percutaneous vertebroplasty (PVP) is a minimally invasive procedure that allows for treating or preventing vertebral fractures resulting from trauma, osteoporosis, or oncological conditions. Metastatic spinal disease is a condition that necessitates mostly palliative care and pain management with minimal invasiveness. It could present with axial or localized back pain and may be associated with neurological deficit if compression of the spinal cord and/or the nerve roots is involved. The treatment of such patients may present a challenge and is usually accomplished with open surgery and instrumentation. However, the potential perioperative complications of invasive surgical procedures may significantly worsen the quality of life in patients with an already poor prognosis. This case report presents minimally invasive management of multiple spinal metastases of the lumbar region in a 65-year-old female patient. She had a history of breast cancer and presented only with axial pain in the lumbar region and no neurological deficit. We performed a biopsy at the L3 level and multi-level PVP at the Th12-L5 levels; her pain diminished significantly, and she was mobilized later on the day of the surgery with a lumbar orthosis brace. Postoperative radiographic evaluation showed satisfactory cement distribution. The patient was subsequently referred to radiotherapy according to the decision of the multidisciplinary oncological committee.