Vertebroplasty for the compression of the dorsal root ganglion due to spinal metastasis

Abstract

Background: Radicular pain has been considered to be a relative contraindication to vertebroplasty. It was reported by some authors in the literature that percutaneous vertebroplasty (PV) in these conditions were performed without complications. Objective: We describe a patient with radicular pain related to compression of the dorsal root ganglion by malignant tumor which was relieved after PV. Study Design: Case report. Setting: Pain management clinic. Case Report: A 52-year-old man with spine metastasis involving the dorsal root ganglion of the left L4 nerve was admitted to the pain clinic with a tingling sensation and pain in both legs for 6 months. He was not able to lie on his back with his left leg extended or stand without weakness. The transforaminal epidural block had only a transient effect. The patient planned to undergo PV. He complained of severe radicular pain in his left leg approximately 5 minutes after the vertebroplasty. A left L4/5 transforaminal epidural block was performed. The next day, the patient's pain was relieved without any complications. He underwent palliative radiation therapy for multiple metastases of the thoracolumbar spine. At 5 months follow-up, he could lie on his back without recurrence of radicular pain. Limitations: This report describes a single case report. Conclusion: We suggest that carefully performed PV is an option for terminally ill patients with epidural and dorsal root ganglion involvement who do not respond to conservative treatment or cannot undergo radiation therapy and surgery. PV is minimally invasive compared to open surgery and may merit serious consideration in patients with limited physiologic reserves.