Percutaneous Vertebroplasty Combined with Iodine-125 Seed Implantation for Spinal Metastases with Dural Sac Compression: A Retrospective Comparative Study.

Abstract

To evaluate the efficacy and safety of percutaneous vertebroplasty (PVP) combined with iodine-125 seed implantation versus PVP alone for spinal metastases with dural sac compression. This retrospective comparative study analyzed 55 patients (75 vertebrae) treated between June 2013 and June 2021. Patients were categorized into 2 groups: the Combined Group (n = 25, 40 vertebrae) received PVP plus iodine-125 seed implantation, and the Control Group (n = 30, 35 vertebrae) received PVP alone. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain, Karnofsky Performance Score (KPS) for functional status, and follow-up imaging for local tumor control. Technical success was 100% in both groups. While both techniques provided initial pain relief, the Combined Group demonstrated significantly superior long-term outcomes. At 12 months, the Combined Group had lower mean VAS scores (2.08 ± 1.97 vs. 4.04 ± 0.93) and higher mean KPS (90.80 ± 1.17 vs. 64.00 ± 3.04) compared to the Control Group. Intragroup analysis revealed that the Control Group showed no significant improvement in VAS or KPS beyond 3 and 6 months, respectively. The local tumor control rate was significantly higher in the Combined Group (80%) than in the Control Group (55.5%). No serious complications, such as spinal cord injury or pulmonary embolism, occurred in either cohort. PVP combined with interstitial iodine-125 seed implantation is a feasible, safe, and effective alternative to PVP alone. This combined approach offers superior sustained pain relief and local tumor control for patients with spinal metastases involving dural sac compression.