Kyphoplasty for Malignant Mesothelioma Metastasis to the L5 Vertebra for Spine Stabilization

Malignant mesothelioma (MM) is an aggressive primary malignancy which invades the pleura, peritoneum or pericardium. Mortality rates are high. Local tumor invasion is inevitable; and metastasis to the chest wall, mediastinum, or thoracic spine is common. Distal metastasis to osseous structures other than the thoracic spine is rare. External beam radiation therapy (EBRT) is a mainstay treatment for metastatic disease in the spine but carries significant risks of myelopathy and unintended damage to normal surrounding tissues and is insufficient when mechanical instability of the affected vertebra is present. Further, EBRT may take up to 2 weeks to elicit meaningful pain relief. Balloon kyphoplasty (KP) is a brief, safe, outpatient, image-guided percutaneous procedure performed with either twilight sedation or general anesthesia. The ideal KP candidate has midline non-radiating pain which worsens with weight bearing and direct palpation at the site of vertebral metastasis or fracture, and pain which improves in the supine position. We present a rare case of L5 vertebral metastasis from end-stage recalcitrant MM treated with KP for pain control and vertebral body stabilization. KP should be considered as a palliative treatment option, with strong evidence to suggest predictable pain relief and improved function when appropriate candidates are selected for the procedure. Caregivers should be aware of the indications of KP as well as expected outcomes.