Stereotactic Vertebroplasty for Spinal Metastases with Multilevel Bilateral Pedicle Fractures: A Technical Note

Ziu, Mateo; Traylor, Jeffrey I.; Paxman, Jason; Goodgame, Boone

doi:10.7759/cureus.4123

Cited by 8 publications

(9 citation statements)

References 7 publications

(8 reference statements)

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“…10 Spinal metastases can cause significant morbidity and mortality because of pain, deformity, and loss of function, especially when tumor burden encroaches on neural elements. 11 Surgical interventions, specifically in cases of spinal cord compression, have been shown to significantly reduce neurological decline and afford patients the ability to maintain independence longer. 12…”

Section: Discussionmentioning

confidence: 99%

Applications of Carbon Fiber Instrumentation in Spinal Oncology: Recent Innovations in Spinal Instrumentation and 2-Dimensional Illustrative Operative Video

Visco

Ojukwu

et al. 2022

Operative Neurosurgery

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BACKGROUND:The management of spinal oncology necessitates a multimodal approach, with surgical intervention, radiation-based therapy, and postoperative advanced imaging. These systems must work well together to provide optimal patient outcomes. Traditional metallic spinal implants produce image artifacts and lead to radiation dose attenuation, which inhibit both disease monitoring and disease treatment, respectively. OBJECTIVE: To demonstrate the feasibility of an improved biomaterial implant that provides structural stability, while also allowing for disease monitoring and treatment in spinal oncology patients. METHODS: From February 2021 to September 2021, 3 patients with spinal oncologic deformity requiring resection and posterior spinal stabilization underwent fixation with polyether ether ketone-carbon fiber implants at a single academic institution. RESULTS: Patient ages ranged from 23 to 74 years (mean: 44.7 years). All patients underwent posterior spinal fixation using standard approaches. They each received polyether ether ketone-carbon fiber pedicle screw and rod implants, placed in standard fashion. There were no dural tears, postoperative wound infections, or other complications related to their treatment. Postoperative surveillance revealed gross total resection of the targeted tumor on postoperative radiographic imaging. CONCLUSION: Polyether ether ketone-carbon fiber implants are a safe and effective option for the treatment of thoracolumbar posterior spinal pathology. The utilization of this novel type of instrumentation in posterior spinal approaches may provide benefit to patients with spinal tumors over existing forms of posterior spinal instrumentation.

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Section: Discussionmentioning

confidence: 99%

Applications of Carbon Fiber Instrumentation in Spinal Oncology: Recent Innovations in Spinal Instrumentation and 2-Dimensional Illustrative Operative Video

Visco

Ojukwu

et al. 2022

Operative Neurosurgery

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“…In pathological vertebral fractures anatomy can be altered and the pedicles are not always easy to identify. New navigation technologies can help the surgeon to avoid trocar malplacement in those cases 31 and also reduce surgery time and radiation dose. 32 Our study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs

González

Llombart-Blanco

Ángulo

et al. 2021

Global Spine Journal

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Study Design: Animal experimental model. Objective: To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs. Methods: We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed. Results: The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis. Conclusions: Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed.

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“…In the literature, there are several studies comparing kyphoplasty with vertebroplasty and unilateral PMMA injection with bilateral PMMA injection [15][16][17][18][19][20]. There are many studies in this regard; however, the number of studies comparing the clinical results of different PMMA injection volumes is quite limited.…”

Section: Discussionmentioning

confidence: 99%

Clinical Comparison of Low and High Injection Volumes of High-viscosity Bone Cement Used in Percutaneous Vertebroplasty

Ozger¹,

Kaplan²

2021

J Minim Invasive Spine Surg Tech

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Objective: To compare the clinical effects of different injection volumes of high-viscosity bone cement (polymethylmethacrylate, PMMA) used in percutaneous vertebroplasty (PVP) on the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: A total of 44 patients with OVCF, who underwent PVP in our neurosurgery clinic, were retrospectively reviewed. Data of the patients were obtained from electronic patient records. Patients were divided into two groups, each consisting of 22 patients, based on the injection volume of PMMA: low-volume (Group 1) and high-volume (Group 2). Group 1 received ≤ 4 mL (3-4 mL) PMMA whereas Group 2 received > 4 mL (4.5-6 mL) PMMA. Both groups were compared in terms of age, gender, visual analog scale (VAS) score, Oswestry disability index (ODI) score, length of stay (LoS) in the hospital, and preoperative anterior vertebral height (AVH). Results: There was no significant difference between the groups in terms of age, gender, LoS, and preoperative AVH. Postoperative first-month, sixth-month, and first-year VAS and ODI scores were observed to be significantly improved in both groups compared to the preoperative period. However, no significant difference was observed between the groups in terms of preoperative and postoperative VAS and ODI scores. Conclusion:The PMMA volumes of 3-4 mL and 4.5-6 mL applied in the present study have been observed to have good and similar effects in the treatment of OVCF.

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Stereotactic Vertebroplasty for Spinal Metastases with Multilevel Bilateral Pedicle Fractures: A Technical Note

Cited by 8 publications

References 7 publications

Applications of Carbon Fiber Instrumentation in Spinal Oncology: Recent Innovations in Spinal Instrumentation and 2-Dimensional Illustrative Operative Video

Applications of Carbon Fiber Instrumentation in Spinal Oncology: Recent Innovations in Spinal Instrumentation and 2-Dimensional Illustrative Operative Video

Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs

Clinical Comparison of Low and High Injection Volumes of High-viscosity Bone Cement Used in Percutaneous Vertebroplasty

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