Directed Injection of Vertebroplastic Cement at the Site of a Lytic Metastatic Lesion Restores Strength With Minimum Injection Volume

2012 ◽  
Author(s):  
Ata M. Kiapour ◽  
Eeric Truumees ◽  
Vijay K. Goel ◽  
Constantine K. Demetropoulos
Keyword(s):  
Metastatic Disease ◽  
Thoracolumbar Spine ◽  
Pathologic Fracture ◽  
Osteoporotic Fractures ◽  
Clinical History ◽  
Metastatic Lesion ◽  
Cement Augmentation ◽  
Adjacent Segment ◽  
Tumor Lysis ◽  
Vertebral Stabilization

Metastatic disease in the thoracolumbar spine represents a large and growing problem. These metastases can lead to pain, pathologic fracture, and neurologic compromise. Over the last two decades, the utilization of polymethylmethacrylate (PMMA) for percutaneous vertebral stabilization has increased. Most of the biomechanical and outcomes data addresses the use of vertebroplasty and kyphoplasty procedures for osteoporotic fractures [1,2]. Use of these procedures for metastatic disease enjoys a long clinical history, but the outcomes and complications are notably higher than in osteoporosis [3,4]. Newer formulations of PMMA used in advanced systems such as the Perimeter System (DePuy, Raynham, MA) may allow carefully controlled, anatomically directed PMMA application with far greater control. However, The relative benefits of these newer, proprietary systems have not been demonstrated. Proposed benefits of direct void reconstruction, as opposed to anterior vertebral body fill include: tumor lysis, decreased risk of later tumor growth with canal compromise, the ability to use less total PMMA, decreased impact on adjacent segment mechanics, and therefore, a decreased adjacent segment fracture risk. This study was conducted to examine and compare the biomechanical effectiveness of the cement augmentation (vertebroplasty) and directed PMMA injection using the Perimeter system.

Anterior bone cement augmentation in anterior lumbar interbody fusion and percutaneous pedicle screw fixation in patients with osteoporosis

2010 ◽  
Vol 12 (5) ◽  
pp. 525-532 ◽  
Author(s):  
Kyeong Hwan Kim ◽  
Sang-Ho Lee ◽  
Dong Yeob Lee ◽  
Chan Shik Shim ◽  
Dae Hyeon Maeng
Keyword(s):  
Vertebral Body ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Cement Augmentation ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Group I ◽  
Cage Subsidence ◽  
The Mean ◽  
Group Ii

Object The purpose of the present study was to evaluate the efficacy of anterior polymethylmethacrylate (PMMA) cement augmentation in instrumented anterior lumbar interbody fusion (ALIF) for patients with osteoporosis. Methods Sixty-two patients with osteoporosis who had undergone single-level instrumented ALIF for spondylolisthesis and were followed for more than 2 years were included in the study. The patients were divided into 2 groups: instrumented ALIF alone (Group I) and instrumented ALIF with anterior PMMA augmentation (Group II). Sixty-one patients were interviewed to evaluate the clinical results, and plain radiographs and 3D CT scans were obtained at the last follow-up in 46 patients. Results The mean degree of cage subsidence was significantly higher in Group I (19.6%) than in Group II (5.2%) (p = 0.001). The mean decrease of vertebral body height at the index level was also significantly higher in Group I (10.7%) than in Group II (3.9%) (p = 0.001). No significant intergroup differences were observed in the incidence of radiographic adjacent-segment degeneration (ASD) or in terms of pain and functional improvement. The incidences of clinical ASD (23% in Group I and 10% in Group II) were not significantly different. There was 1 case of nonunion and 3 cases of screw migration in Group I, but none resulted in implant failure. Conclusions Anterior PMMA augmentation during instrumented ALIF in patients with osteoporosis was useful to prevent cage subsidence and vertebral body collapse. In addition, PMMA augmentation did not increase the nonunion rate and incidence of ASD.

Use of the SpineJack direct reduction for treating type A2, A3 and A4 fractures of the thoracolumbar spine: a retrospective case series

2021 ◽  
pp. neurintsurg-2021-017682
Author(s):  
Giorgio Lofrese ◽  
Luca Ricciardi ◽  
Pasquale De Bonis ◽  
Francesco Cultrera ◽  
Michele Cappuccio ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Direct Reduction ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Osteoporotic Fractures ◽  
Neurological Impairment ◽  
Radiological Outcome ◽  
Retrospective Case ◽  
Younger Patients ◽  
Kyphosis Correction

BackgroundCompression injuries of the thoracolumbar spine without neurological impairment are usually treated with minimally invasive procedures. Intravertebral expandable implants represent an alternative strategy in fractures with low fragments’ displacement.MethodsPatients with A2, A3 and A4 fractures of the T10–L2 spinal segment without neurological impairment, fracture gap >2 mm, vertebra plana, pedicle rupture, pedicle diameter <6 mm, spinal canal encroachment ≥50%, and vertebral body spread >30% were treated with the SpineJack device. Patients with pathological/osteoporotic fractures were excluded. Demographic and fracture-related data were assessed together with vertebral kyphosis correction, vertebral height restoration/loss of correction and final kyphosis. The modified Rankin Scale (mRS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Smiley–Webster Pain Scale (SWPS) and EuroQol-5D (EQ-5D) were evaluated at 1 (-post), 6 and 12 months (-fup) after surgery. Statistical analysis was performed and p values ≤0.05 were considered significant.ResultsFifty-seven patients were included in the study. Patients aged >60 years reported worse kyphosis correction (<4°) with more postoperative complications, while vertebral plasticity in younger patients, fragmentation-related greater remodeling in A3/A4 fractures, and treatments within 7 days of trauma determined superior wedging corrections, with better EQ-5D-post and mRS-fup. Cement leakages did not affect functional outcome, while female gender and American Society of Anesthesiologists (ASA) score of 3–4 were associated with worse ODI-fup and VAS-fup. Although fracture characteristics and radiological outcome did not negatively influence the clinical outcome, A2 fracture was a risk factor for complications, thus indirectly compromising both the functional and radiological outcome.ConclusionWith spread of <30%, the SpineJack is an alternative to minimally invasive fixations for treating A3/A4 thoracolumbar fractures, being able to preserve healthy motion segments in younger patients and provide an ultra-conservative procedure for elderly and fragile patients.

Spine

2020 ◽  
pp. 103-120
Author(s):  
Allan D. Levi
Keyword(s):  
New Technologies ◽  
Thoracolumbar Spine ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Metastatic Lesion ◽  
Oral Exam ◽  
Spine Deformity ◽  
Thoracic Disc ◽  
Cervical Plating ◽  
Invasive Techniques

Spine cases form a significant component of the neurosurgery Oral Board Examinations. A familiarity with the common cases is essential in preparing for the boards. Spine includes cases that span from the skull base to the sacrum. Another component of spine includes an understanding of spine stability as well as the use of spinal instrumentation such as cervical plating and pedicle screws. These techniques are now a standard part of the neurosurgical armamentarium. Current new technologies or approaches to the spine whether minimally invasive techniques or surgery for deformity are actively used and will continue to form a larger part of the oral exam. The following cases are discussed in this chapter: bilateral cervical facet dislocation with spinal cord injury, central calcified thoracic disc herniation, L5 congenital spondylolysis with spondylolisthesis, metastatic lesion, and a thoracolumbar spine deformity.

scholarly journals Improving functional outcome and quality of life for patients with metastatic lesion of acetabulum undergoing cement augmentation

Medicine ◽  
2019 ◽  
Vol 98 (36) ◽  
pp. e17029
Author(s):  
Taiqiang Yan ◽  
Zhiqing Zhao ◽  
Xiaodong Tang ◽  
Wei Guo ◽  
Rongli Yang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcome ◽  
Metastatic Lesion ◽  
Cement Augmentation

scholarly journals The Imaging and Pathological Features of Metastatic Leiomyosarcoma in the Gallbladder

Rare Tumors ◽  
2016 ◽  
Vol 8 (4) ◽  
pp. 179-181 ◽  
Author(s):  
Yi Guo ◽  
Eleanor Chen ◽  
Darin J. Davidson ◽  
Venu G. Pillarisetty ◽  
Robin L. Jones ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Uterine Fibroids ◽  
Exploratory Laparotomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Metastatic Lesion ◽  
Uterine Leiomyosarcoma ◽  
High Grade ◽  
Initial Management ◽  
Pelvic Radiation

Uterine leiomyosarcoma is a rare and aggressive malignancy with poor overall prognosis. There have been few reports of metastatic leiomyosarcoma in the gallbladder. We report a case of a 41-year-old female who underwent total abdominal hysterectomy due to presumed uterine fibroids. The postoperative pathology revealed high-grade pleomorphic leiomyosarcoma, with involvement of the uterine serosal surface. She subsequently underwent exploratory laparotomy, followed by pelvic radiation and chemotherapy. Since initial management she has developed metastatic disease and has been under treatment and surveillance for 11 years. She has undergone multiple surgical procedures and numerous lines of systemic therapy for metastatic leiomyosarcoma, including cholecystectomy for a metastatic lesion in the gallbladder. There have been no previous reports of metastatic leiomyosarcoma in the gallbladder. Despite extensive metastatic disease this patient has had prolonged survival with multi-modality management.

scholarly journals Metastasis of Colon Cancer to the Breast

2017 ◽  
Vol 10 (1) ◽  
pp. 77-80 ◽  
Author(s):  
Swei H. Tsung
Keyword(s):  
Colon Cancer ◽  
Metastatic Disease ◽  
Rare Event ◽  
Clinical History ◽  
Primary Cancer ◽  
Breast Metastases ◽  
Proper Diagnosis ◽  
High Level

Breast metastases from extramammary neoplasms are extremely rare, and even more so is metastasis of colon cancer to the breast. Despite its rarity, metastatic disease to the breast is an important diagnostic issue because its treatment differs greatly from that of primary cancer. Proper diagnosis of this rare event requires an accurate clinical history, proper immunohistochemical workup, and a high level of suspicion.

scholarly journals A Systematic Review of Treatment Strategies for the Prevention of Junctional Complications After Long-Segment Fusions in the Osteoporotic Spine

2020 ◽  
pp. 219256822093990 ◽  
Author(s):  
Murray Echt ◽  
William Ranson ◽  
Jeremy Steinberger ◽  
Reza Yassari ◽  
Samuel K. Cho
Keyword(s):  
Systematic Review ◽  
Thoracolumbar Spine ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Compression Fracture ◽  
Deformity Correction ◽  
Preventive Treatment ◽  
Cement Augmentation ◽  
Mineral Density ◽  
Junctional Kyphosis

Study Design: Systematic review Objectives: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are well-known complications after long-segment fusions in the thoracolumbar spine of osteoporotic patients. Recent advances in anti-resorptive and anabolic medications, instrumentation, surgical technique, and cement augmentation have all aided in the avoidance of junctional kyphosis. In this article, current literature on the prevention of PJK and PJF in the osteoporotic spine is reviewed. Methods: A systematic literature review was conducted using the PubMed/MEDLINE and Embase databases in order to search for the current preventive treatment methods for PJK and PJF published in the literature (1985 to present). Inclusion criteria included (1) published in English, (2) at least 1-year mean and median follow-up, (3) preoperative diagnosis of osteoporosis, (4) at least 3 levels instrumented, and (5) studies of medical treatment or surgical techniques for prevention of junctional kyphosis. Results: The review of the literature yielded 7 studies with low levels of evidence ranging from level II to IV. Treatment strategies reviewed addressed prophylaxis against ligamentous failure, adjacent vertebral compression fracture, and/or bone-implant interface failure. This includes studies on the effect of osteoporosis medication, cement augmentation, multi-rod constructs, and posterior-tension band supplementation. The role of perioperative teriparatide therapy maintains the highest level of evidence. Conclusions: Perioperative teriparatide therapy represents the strongest evidence for preventive treatment, and further clinical trials are warranted. Use of cement augmentation, sublaminar tethers, and multi-rod constructs have low or insufficient evidence for recommendations. Future guidelines for adult spinal deformity correction may consider bone mineral density–adjusted alignment goals.

Biomechanical analysis of stiffness and fracture displacement after using PMMA-augmented sacroiliac screw fixation for sacrum fractures

2017 ◽  
Vol 62 (4) ◽  
pp. 421-428 ◽  
Author(s):  
Andreas Höch ◽  
Richard Schimpf ◽  
Niels Hammer ◽  
Stefan Schleifenbaum ◽  
Michael Werner ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Pedicle Screws ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Cement Augmentation ◽  
Biomechanical Analysis ◽  
Human Donor ◽  
Sacroiliac Screw ◽  
Fracture Stabilization ◽  
Sacroiliac Screw Fixation

AbstractCement augmentation of pedicle screws is the gold standard for the stabilization of osteoporotic fractures of the spine. In-screw cement augmentation, in which cement is injected through the cannula, is another option for fracture stabilization of fragility fractures of the sacrum. However, biomechanical superiority of this technique compared to conventional sacroiliac screw fixation has not been tested. The present study compares the stability of cement-augmented and non-cement-augmented sacroiliac screw fixation in osteoporotic sacrum fractures under cyclic loading. Eight human donor pelvises with intact ligaments and 5

scholarly journals Clinical Evaluation of Percutaneous Vertebroplasty in a Patient with Paraplegia and Immobilization Syndrome: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Salvatore Masala ◽  
Eros Calabria ◽  
Marco Nezzo ◽  
Dominique De Vivo ◽  
Luca Neroni ◽  
...  
Keyword(s):  
Potential Role ◽  
Percutaneous Vertebroplasty ◽  
Life Quality ◽  
Osteoporotic Fractures ◽  
Well Being ◽  
Vertebral Compression Fractures ◽  
Decubitus Ulcers ◽  
Compression Fractures ◽  
Vertebral Stabilization

We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of a patient with immobilization syndrome due to paraplegia and vertebral osteoporotic fractures. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization in patient with immobilization syndrome has not been reported in the literature. A 73-year-old woman affected by immobilization syndrome due to paraplegia and vertebral osteoporotic fractures was treated with PVP of vertebrae D12, L1, and L4. After PVP, the patient did not need any antalgic therapy, and there was a significant improvement regarding mobilization, performance of physiological functions, daily management of personal care, and treatment of decubitus ulcers, increasing life quality and psychological well-being.

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