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Journal of Neurology and Neurorehabilitation Research | Volume 3
November 26-27, 2018 | Dubai, UAE
Spine and Spine Disorders
Addiction Research and Therapy
3rd International Conference on
International Conference on
Joint Event
&
Early Vertebroplasty for Spinal Metastatic Pain and Metastatic Fractures
Pankaj Nishikant Surange
Interventional Pain and Spine Centre, India
P ain due to Spinal Bony Metastasis and Metastatic Fractures
in not uncommon. Most of these patients suffer from
severe pain and do not respond adequately to medical
management. Moreover, some of these patients have limited
life expectancy and some of them have already reached the
maximum radiation dose or have considerable side effects of
radiotherapy, which is the mainstay of treatment. Specially,
with Metastatic Fractures, it becomes difficult to heal due to
loss of bony structures and these fractures make them crippled
and leads to other complications related to loss of movements
like Deep Vein Thrombosis, Bed-sores, Atelectasis.
90%of Vertebral Column Tumors are caused bymetastasis from
other organs. The vertebral column is the most common site of
metastasis within the skeletal system, with 70% of diagnosed
patients showing bone metastasis Sites of metastasis break
down to 60-80% in the thoracic spine, 15-30% in the lumbar
spine and <10% in the cervical spine. In 30% of Vertebral
Setastasis from solid tumors, VCF occurs by reduction of
vertebral bone strength via osteoblastic or osteoclastic activity.
Spinal Metastasis can lead to economic loss, severe pain,
neurologic injury, decreased life quality and even death.
Early diagnosis and treatment of Spinal Metastasis and
Metastatic fracture can preserve the patient’s quality of life and
the possibility of physical activities. Conventional treatments
include surgery, chemotherapy, hormone therapy, and medical
therapy. Although treatment can increase the median survival
rate, for most patients, the purpose of treatment is reduction of
pain, local disease progression, spinal instability, and neurologic
complications. Pharmacotherapy using anti-inflammatory drugs
(NSAID) and opioids are first used to treat pain but requires
extended periods of bed rest. Since cancer and its treatment
reduce the patient’s immunity and cause the patient to be in
a hyper-coagulation state, prolonged bed rest may increase
morbidity from infection, Pneumonia, Deep Vein Thrombosis,
and Pulmonary Embolism. External Beam Radiation Therapy
(EBRT) is effective against pain but requires at least 2-6 weeks
to obtain results. Also, since continuous conventional EBRT can
injure normal tissues and the nearby spinal cord, the procedure
is limited by inevitable reduction of radiation dosage.
PVP is a minimally invasive method that can be performed
under local anaesthesia with few complications; it can lead
to rapid and effective cancer pain reduction with mechanical
stability. Pain reduction after PVP is due to increased spine
stability, tumor necrosis, and sensory nerve ending destruction.
Tissue destruction occurs through highly exothermic reactions
and local cytotoxic effects of Polymethyl Methacrylate (PMMA)
polymerization. Furthermore, PMMA not only acts as an
analgesic but also has antitumor effects. PMMA applied to a
malignant vertebral body can cause tumor necrosis through
its cytotoxic activity, thermal effect, and ischemia effect.
Space-occupying cement blocks tumor cell growth. An early
management with Percutaneous Vertebroplasty in Spinal
Metastasis and particularly in Metastatic fracture can improve
the quality of life and reduce their sufferings and complications.
Speaker Biography
Pankaj Nishikant Surange has completed his MBBS from G R Medical College, Gwalior,
India; after which he had done MD (Anesthesiology) from Army Base Hospital, New
Delhi, India. He has also done fellowship on Interventional Pain Practice-Budapest
at Hungary. Currently he is director at Interventional Pain and Spine Center (IPSC
India) located at New Delhi, India. He is Honary Secretary of Indian society for study
of pain. He is Ex-Chairman of World Institute of Pain, India Sri Lanka Bangladesh and
Pakistan Section; Founder member and Treasurer for Musculoskeletal Ultrasound
Society of India and Founder member and Hon Secretary, Neuromodulation Spine
society of India International Member of Spine Intervention Society. He is Academic
head of Symbiosis International University for Pain management courses and
invited faculty at various national and International conferences 2 Editorials and
3 International and 5 National Publications Book Chapters: 3. He was Recipient
of Pain Awareness Ambassador Award 2015, Excellence in pain practice award by
World Institute of pain 2017 and National Pain Physician of the year Award 2016.
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