Vertebral Augmentation for Neoplastic Lesions with Posterior Wall Erosion and Epidural Mass

Cianfoni, Alessandro; Raz, Eytan; Mauri, Sílvia; Lascio, Simona Di; Reinert, Michael; Pesce, G.; Bonaldi, Giuseppe

doi:10.3174/ajnr.a4096

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…As far as we know, there are no data about the rate of PMMA leakage in patients with EO of the VB treated with VBS. A previous study34 reported a low complication rate (1.4%) during VA of neoplastic lytic lesions with a dehiscent posterior wall, and our results seem to support the use of VBS as a safe procedure even in patients with EO.…”

Section: Complicationssupporting

confidence: 85%

Vertebral body stent augmentation to reconstruct the anterior column in neoplastic extreme osteolysis

Cianfoni

Distefano

Pravatà

et al. 2018

J NeuroIntervent Surg

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BackgroundExtensive lytic lesions of the vertebral body (VB) increase risk of fracture and instability and require stabilization of the anterior column. Vertebral augmentation is an accepted treatment option, but when osteolysis has extensively destroyed the VB cortical boundaries (a condition herein defined as ‘extreme osteolysis’), the risk of cement leakage and/or insufficient filling is high. Vertebral body stents (VBSs) might allow partial restoration of VB height, cement containment, and reinforcement, but their use in extreme osteolysis has not been investigated.ObjectiveTo assess retrospectively the feasibility and safety of VBS augmentation in patients with ‘extreme osteolysis’ of the VB.MethodsWe retrospectively analyzed 41 treated vertebrae (from T1 to L5). VB reconstruction was assessed on postprocedure CT images and rated on a qualitative 4-point scale (poor-fair-good-excellent). Clinical and radiological follow-up was performed at 1 month and thereafter at intervals in accordance with oncological protocols.ResultsVBS augmentation was performed at 12 lumbar and 29 thoracic levels, with bilateral VBS in 23/41. VB reconstruction was judged satisfactory (good or excellent) in 37/41 (90%) of levels. Bilateral VBS received higher scores than unilateral (p=0.057, Pearson’s X2). We observed no periprocedural complications. Cement leaks (epidural or foraminal) occurred at 5/41 levels (12.2%) without clinical consequences. Follow-up data were available for 27/29 patients, extending beyond 6 months for 20 patients (7–28 months, mean 15.3 months). VBS implant stability was observed in 40/41 cases (97.5%).ConclusionsOur results support the use of VBS as a minimally invasive, safe and effective option for reconstructing the anterior column in prominent VB osteolysis.

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Section: Complicationssupporting

confidence: 85%

Vertebral body stent augmentation to reconstruct the anterior column in neoplastic extreme osteolysis

Cianfoni

Distefano

Pravatà

et al. 2018

J NeuroIntervent Surg

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“…In the group of patients with available VAS assessment, there was significant and sustained pain reduction as expected compared with previously published larger series using similar treatment techniques. 36 In the 41 levels with available follow-up, the results obtained with AKP were confirmed to be stable at a mean follow-up of 8 months (range, 1-36 months) because in 38/ 41, the postoperative VBH was either stable or showed only minimal endplate subsidence (Fig 3); only in 3 cases did we encounter a refracture of the vertebral body treated with AKP, with VBH loss. As to a PWR correction, 14/22 patients who had cross-sectional imaging follow-up available showed stable PWR at follow-up.…”

Section: Discussionmentioning

confidence: 71%

“…In this study, we included 8 neoplastic fractures that had a retropulsed bone fragment (Fig 2), while we did not include cases with epidural nonosseous soft-tissue masses. An epidural soft-tissue mass might, in fact, behave differently from an osseous PWR and would have been more difficult to measure on postoperative CT. Intraoperative myelography, already described in the setting of vertebral augmentation procedures at risk for central canal encroachment, 36 was used in only a minority of cases in this series, but it seemed potentially useful in selected patients to have a visual control under fluoroscopy of the PWR and to directly demonstrate the effect of ligamentotaxis during fracture reduction (Fig 1). We found a statistically significant difference between the mean degree of PWR and VBH pre-and postoperatively, which suggests the biomechanical effectiveness of the technique.…”

Section: Discussionmentioning

confidence: 99%

Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures

Venier¹,

Roccatagliata

Isalberti

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Burst fractures are characterized by middle column disruption and may feature posterior wall retropulsion. Indications for treatment remain controversial. Recently introduced vertebral augmentation techniques using intravertebral distraction devices, such as vertebral body stents and SpineJack, could be effective in fracture reduction and fixation and might obtain central canal clearance through ligamentotaxis. This study assesses the results of armed kyphoplasty using vertebral body stents or SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion. MATERIALS AND METHODS: This was a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre-and postprocedural CT. Clinical and radiologic follow-up charts were reviewed. RESULTS: Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively (P , .001), and mean vertebral body height was 10.8 and 16.7 mm, respectively (P , .001). No significant clinical complications occurred. Clinical and radiologic follow-up (1-36 months; mean, 8 months) was available in 39 patients. Three treated levels showed a new fracture during follow-up without neurologic deterioration, and no retreatment was deemed necessary. CONCLUSIONS: In the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplasty yields fracture reduction, internal fixation, and indirect central canal decompression. In selected cases, it might represent a suitable minimally invasive treatment option, stand-alone or in combination with posterior stabilization.

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“…Another described technique for cavity creation, the percutaneous controlled ablation (coblation), utilizes a plasma field to evaporate tumor cells at low temperatures, in theory allowing subsequent low-pressure cement injection with a reduced risk of cement leaks and epidural tumor displacement [3,27,28]. This technology, characterized by technical limitations in addressing large soft tissue lesions [24] and high costs, is no longer commercially available.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous vertebral augmentation (VA) with vertebroplasty (PVP), balloon kyphoplasty (BKP), or vertebral body stenting (VBS) is often performed in patients with painful, fractured, or at-risk-of-fracture neoplastic spinal lytic lesions. The main goals are reinforcement of the vertebral body, stabilization or prevention of a fracture, and pain relief [1,2,3,4,5,6]. However, complication rate of VA, including cement pulmonary embolism and epidural cement leakage, is higher in patients with neoplastic when compared with osteoporotic fractures [7,8].…”

Section: Introductionmentioning

confidence: 99%

Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation

et al. 2019

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Background and Objectives: We describe a novel technique for percutaneous tumor debulking and cavity creation in patients with extensive lytic lesions of the vertebral body including posterior wall dehiscence prior to vertebral augmentation (VA) procedures. The mechanical cavity is created with a combination of curettage and vacuum suction (Q-VAC). Balloon kyphoplasty and vertebral body stenting are used to treat neoplastic vertebral lesions and might reduce the rate of cement leakage, especially in presence of posterior wall dehiscence. However, these techniques could theoretically lead to increased intravertebral pressure during balloon inflation with possible mobilization of soft tissue tumor through the posterior wall, aggravation of spinal stenosis, and resultant complications. Creation of a void or cavity prior to balloon expansion and/or cement injection would potentially reduce these risks. Materials and Methods: A curette is coaxially inserted in the vertebral body via transpedicular access trocars. The intravertebral neoplastic soft tissue is fragmented by multiple rotational and translational movements. Subsequently, vacuum aspiration is applied via one of two 10 G cannulas that had been introduced directly into the fragmented lesion, while saline is passively flushed via the contralateral cannula, with lavage of the fragmented solid and fluid-necrotic tumor parts. Results: We applied the Q-VAC technique to 35 cases of thoracic and lumbar extreme osteolysis with epidural mass before vertebral body stenting (VBS) cement augmentation. We observed extravertebral cement leakage on postoperative CT in 34% of cases, but with no clinical consequences. No patients experienced periprocedural respiratory problems or new or worsening neurological deficit. Conclusion: The Q-VAC technique, combining mechanical curettage and vacuum suction, is a safe, inexpensive, and reliable method for percutaneous intravertebral tumor debulking and cavitation prior to VA. We propose the Q-VAC technique for cases with extensive neoplastic osteolysis, especially if cortical boundaries of the posterior wall are dehiscent and an epidural soft tissue mass is present.

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Vertebral Augmentation for Neoplastic Lesions with Posterior Wall Erosion and Epidural Mass

Cited by 9 publications

References 31 publications

Vertebral body stent augmentation to reconstruct the anterior column in neoplastic extreme osteolysis

Vertebral body stent augmentation to reconstruct the anterior column in neoplastic extreme osteolysis

Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures

Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation

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