Curved Vertebroplasty System Combined with Targeted Radionuclide Therapy for Tumor-Related Pathological Vertebral Fractures.

Abstract

Objective: To compare the clinical efficacy of the curved vertebroplasty system combined with targeted radionuclide therapy (radium-223/strontium-89) versus conventional percutaneous vertebroplasty (PVP) combined with radionuclide therapy in the treatment of malignant tumor-related pathological vertebral fractures, and to evaluate differences between the two surgical approaches in postfracture pain relief, vertebral morphological reconstruction, spinal functional recovery, and quality-of-life improvement.

Methods: A retrospective analysis was performed on 125 patients with pathologically confirmed malignant tumor bone metastasis-related pathological vertebral fractures treated between January 2022 and December 2024. All patients received targeted radionuclide therapy, and vertebroplasty was performed 14-21 d after the last radionuclide dose. Patients were divided into the curved vertebroplasty combined with radionuclide therapy group (study group, n = 63) and the conventional PVP combined with radionuclide therapy group (control group, n = 62). The primary outcome was the Visual Analogue Scale (VAS) pain score. Secondary outcomes included the postfracture vertebral height recovery rate, the Oswestry Disability Index (ODI), the Roland-Morris Disability Questionnaire (RMDQ), bone cement distribution, vertebral kyphotic angle, and SF-36 quality-of-life score. Patients were followed for 6 months, and radionuclide therapy-related adverse events were monitored.

Results: Baseline characteristics were comparable between the two groups (p > 0.05). At 3 and 6 months after pathological fracture surgery, VAS scores were significantly lower in the study group than in the control group (1.6 ± 0.8 vs. 2.5 ± 1.0; 1.4 ± 0.7 vs. 2.4 ± 0.9; both p < 0.01). At all postoperative time points, the study group demonstrated significantly superior vertebral height recovery rates, ODI, and RMDQ improvement (all ps < 0.017), as well as a better kyphotic angle correction (p < 0.017). The anterior-middle column bone cement fill rate was significantly higher in the study group (88.4% ± 9.1% vs. 74.6% ± 13.2%, p < 0.001), with no intraspinal cement leakage. All eight SF-36 domain scores were significantly higher in the study group at 6 months (all ps < 0.001). Hematological toxicity rates did not differ significantly between groups (14.3% vs. 12.9%, p = 0.819).

Conclusions: In the surgical management of malignant tumor-related pathological vertebral fractures, the curved vertebroplasty system combined with targeted radionuclide therapy demonstrates significantly superior postfracture pain control, vertebral morphological reconstruction, spinal functional recovery, and quality-of-life improvement compared with conventional PVP combined with radionuclide therapy, without increasing radionuclide-related toxicity. The precise anterior-middle column cement filling achieved by the curved system, combined with the systemic antitumor effect of radionuclide therapy, establishes a synergistic precision treatment model of local surgical reconstruction plus systemic radionuclide therapy for tumor-related pathological vertebral fractures.