Article Figures & Data
Figures
- Fig 1.
A, Axial CT scans show a large degree of cortical disruption in a 70-year-old man with metastatic colon cancer.
B and C, The SpineWand device was inserted into the cannula to perform the tissue ablation; the clinician is capable of ablating tissue in a superior or inferior lateral direction.
D, In this patient, 2 10-mm Kyphon balloons were inserted to obtain hemostasis while preparing the bone cement. A myelogram was performed to clearly delineate the posterior cortical margin.
E, The axial CT scans collected immediately after the procedure showed that cement was cleanly deposited in the ablated tumor void with no posterior extraosseous extension of cement.
- Fig 2.
A, An axial T1-weighted image through the T11 level showing prominent epidural involvement in a 34-year-old woman with multiple myeloma.
B, The axial CT image showed associated cortical disruption.
C, The axial CT images obtained after the procedure, showing adequate cement filling with no epidural extension. Note the tight thecal sac as evident by using myelographic contrast agent.
- Fig 3.
A, The preprocedure axial CT examination showing almost complete absence of the posterior cortex at the L1 level in a 76-year-old man with metastatic hepatoma to the spine.
B, The postprocedural CT axial images showed well-bounded deposition of cement in the anterior part of the vertebral body with no extension into the compromised posterior aspect.
Tables
Patient demographics
Patient Age Sex Treated Level(s) Pathologic Conditions Anatomy of Metastatic Lesion Other Procedures Pain Score (Before–After) Postprocedure CT Group 1 1* 75 F L2 (Vp) Plasmacytoma, history of breast cancer, lupus erythematosus, chronic steroid use Posterior cortical defect Vp, T6, T8, T9, T10 (benign compression fractures) 9/10–2/10 Cement confined to the lytic lesions 2* 71 M L1 (Vp) Lung cancer Epidural extension and posterior cortical defect 9/10–3/10 Cement confined to the lytic lesions 3 27 M T11 (Vp) Undifferentiated testicular malignancy Epidural extension Vp, T12, L1 8/10–5/10, deceased No postprocedure CT; no EE on plain film 4* 82 M L5 (Vp) Lung squamous cell carcinoma Posterior cortical defect and epidural extension; tumor extension into right neural foramen 9/10–5/10 Cement on periphery of the metastatic lesion 5 52 F T9 (Vp) Breast cancer Anterior cortical defect Vp, T5, T7, T10 8/10–5/10 Cement around the lytic lesions 6* 70 M L2 (Kp) Colon cancer Posterior cortical defect 9/10–5/10, deceased Cement confined to the lytic lesions 7* 34 F T12 (Kp) Multiple myeloma Posterior cortical defect and epidural extension Kp, T7,T8, T11 Cannot tell difference Cement confined to the lytic lesions 8 58 F T12 (Kp) Breast cancer Posterior cortical disruption and epidural extension Cervical, sacral, and bilateral hip metastases 9/10–5/10, deceased Cement confined to the lytic lesions 9 80 F L4 (Kp) Stomach & breast cancer Epidural extension and complete absence of posterior cortex on CT Kp, L2; Vp, L3; followed by Kp, T7, T8, T11 7/10–3/10 Cement confined to the lytic lesions 10 76 M L1 (Kp) Hepatoma Posterior cortical disruption Kp, L3 10/10–5/10, deceased Cement confirmed in normal bone anterior to the lytic lesion 11* 72 M L1 (Kp) Multiple myeloma Epidural extension; cortical defect Vp, L2 6/10–2/10 Cement confined to the lytic lesions Group 2 12 56 M L1 (Vp) Renal cell metastasis Paravertebral extension and lateral cortical disruption 2 stage coblation for vertebral & paravertebral components; arterial embolization 8/10–2/10 Cement confined to the lytic lesions; EE through anterolateral cortex 13 36 F L2 (Kp) Cervical cancer Anterior and posterior cortical defect; paraspinal mass extended into left L2–L3 NRB Recurrent lesion after radiation; left L2–L3 NRB 9/10–9/10 Cement confined to the lytic lesions; some anterior EE 14 66 F L3 (Kp right; Vp left) Lung cancer Posterior cortical defect; epidural extension; extension into right neural foramen Right NRB 10/10–0/10 Cement confined to the lytic lesions; EE anteriorly and into right neural foramen 15 68 M L5 (Kp) Urethral cancer Epidural extension and posterior cortical defect; extension into the right pedicle and neural foramen S1 sacroplasty, NRB 9/10–7/10 Cement on periphery of lesion, extending into the right pedicle Note:—EE indicates extraosseous extension of cement; Group 1, bone cement confined to lytic lesions and confined to vertebral body; Group 2, bone cement with extraosseous extension outside vertebral body; Vp, vertebroplasty; Kp, kyphoplasty; NRB, nerve root block.
* Myelogram performed.
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