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

Cianfoni, Alessandro; Distefano, Daniela; Pravatà, Emanuele; Espeli, Vittoria; Pesce, G.; Mordasini, Pasquale; Barbera, Luigi La; Scarone, Pietro; Bonaldi, Giuseppe

doi:10.1136/neurintsurg-2018-014231

Cited by 25 publications

(45 citation statements)

References 31 publications

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“…Cianfoni et al conducted a retrospective evaluation on 29 patients with 41 VCF with extreme osteolysis due to solid metastases, multiple myeloma or plasmacytoma, which aimed at evaluating the VBS ® efficacy with regard to spine stabilization [19]. All patients were implanted with VBS ® under biplanar fluoroscopic guidance, however some patients received additional posterior stabilization (1/29) or posterior stabilization and laminectomy (2/29).…”

Section: Resultsmentioning

confidence: 99%

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture

Cornelis

Joly²,

Nouri-Neuville

et al. 2019

Medicina

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Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

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Section: Resultsmentioning

confidence: 99%

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture

Cornelis

Joly²,

Nouri-Neuville

et al. 2019

Medicina

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“…Stent-Screw Assisted Internal Fixation (SAIF) technique has been recently introduced by Cianfoni et al for the treatment of severe osteoporotic and neoplastic fractures (Cianfoni et al, 2019a,b).…”

Section: Discussionmentioning

confidence: 99%

“…A novel minimally-invasive augmentation technique, called Stent-Screw Assisted Internal Fixation (SAIF, Figure 1) has been recently proposed by Cianfoni et al for the treatment of severe osteoporotic and neoplastic fractures (Cianfoni et al, 2019a,b). The SAIF technique includes insertion and balloon-expansion of two vertebral body stents (VBS), followed by the insertion of percutaneous cannulated and fenestrated pedicular screws.…”

Section: Introductionmentioning

confidence: 99%

“…After the stents are expanded and the screws are in position, the cement is injected through the screws to achieve optimal stents' and VB's filling (endplate-to-endplate). The role of the stents is to help maintain the height restoration achieved by balloon inflation, avoiding deflation effect, and to act as a scaffold that allows homogeneous anterior column augmentation and prevents cement leakage (Rotter et al, 2010; Diel et al, 2013; Cianfoni et al, 2019b).…”

Section: Introductionmentioning

confidence: 99%

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Stent-Screw Assisted Internal Fixation of Osteoporotic Vertebrae: A Comparative Finite Element Analysis on SAIF Technique

Barbera

Cianfoni

Ferrari

et al. 2019

Front. Bioeng. Biotechnol.

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Vertebral compression fractures are one of the most relevant clinical consequences caused by osteoporosis: one of the most common treatment for such fractures is vertebral augmentation through minimally invasive approaches (vertebroplasty or balloon-kyphoplasty). Unfortunately, these techniques still present drawbacks, such as re-fractures of the treated vertebral body with subsidence of the non-augmented portions or re-fracture of the non-augmented middle column at the junction with the augmented anterior column. A novel minimally-invasive augmentation technique, called Stent-Screw Assisted Internal Fixation, has been recently proposed for the treatment of severe osteoporotic and neoplastic fractures: this technique uses two vertebral body stents and percutaneous cannulated and fenestrated pedicular screws, through which cement is injected inside the expanded stents to achieve optimal stents' and vertebral body's filling. The role of the pedicle screws is to anchor the stents-cement complex to the posterior column, acting as a bridge across the middle column and preserving its integrity from possible collapse. In order to evaluate the potential of the new technique in restoring the load bearing capacity of the anterior and middle spinal columns and in reducing bone strains, a Finite Element model of an osteoporotic lumbar spine has been developed. Both standard vertebroplasty and Stent-Screw Assisted Internal Fixation have been simulated: simulations have been run taking into account everyday activities (standing and flexion) and comparison between the two techniques, in terms of strain distribution on vertebral endplates and posterior and anterior wall, was performed. Results show that Stent-Screw Assisted Internal Fixation significantly decrease the strain distribution on the superior EP and the cortical wall compared to vertebroplasty, possibly reducing the re-fracture risk of the middle-column at the treated level.

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“…Cianfoni et al . have shown VBS use as anterior augment in neoplastic osteolysis[ 6 ] and have subsequently reported on a stent screw-assisted technique where after inflation of the VBS, cannulated fenestrated pedicle screws are inserted and cement instillation through the screws is performed. [ 5 ] Their most recent work on combining this technique along with posterior spinal decompression and stabilization in four cases is promising.…”

Section: Discussionmentioning

confidence: 99%

Vertebral body cemented stents combined with posterior stabilization in the surgical treatment of metastatic spinal cord compression of the thoracolumbar spine

Mohammed¹,

Lee²,

Panikkar³

et al. 2020

Surgical Neurology International

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Background: Extensile interventions to provide anterior spinal column support in metastatic spinal cord compression (MSCC) surgery incur added morbidity in this surgically frail group of patients. We present our preliminary results of posterior spinal decompression and stabilization coupled with vertebral body cemented stents for anterior column support in MSCC. Methods: Fourteen patients underwent posterior spinal decompression and pedicle screw construct along with vertebral body stenting (VBS) technique for reconstruction and augmentation of the vertebral body. The primary in all except one was solid organ malignancy and 10 patients (71%) were treatment naïve. The mean revised Tokuhashi score was 10.7 ± 2.7 and the mean spinal instability neoplastic score was 9.6 ± 1.9. All vertebral body lesions were purely lytic and were associated with a cortical defect in the posterior wall. Results: A mean 5.3 ± 2.7 ml low-viscosity polymethyl methacrylate bone cement was injected within the stent at each compression level. No cement extrusion posteriorly was noted in any case from intraoperative fluoroscopy or postoperative radiographs. Five patients died at a mean 6.8 months (range 1–15 months), while the remaining patients have a mean survival of 18 months. Neither further revision surgical intervention nor any neurological deterioration was noted in any patient, who all continued to be ambulatory. The mean postoperative Core Outcome Measures Index score for 11 patients was 4.03 (standard deviation 3.11, 95% confidence interval (1.93–6.12). Conclusion: In lytic vertebral body lesions with posterior wall erosions, cemented VBS technique adds to the surgical armamentarium in MSCC surgery showing promising early results without added complications.

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

Cited by 25 publications

References 31 publications

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture

Stent-Screw Assisted Internal Fixation of Osteoporotic Vertebrae: A Comparative Finite Element Analysis on SAIF Technique

Vertebral body cemented stents combined with posterior stabilization in the surgical treatment of metastatic spinal cord compression of the thoracolumbar spine

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