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 p s < 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 p s < 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.
Zhou et al. (Tue,) studied this question.