title: CT fluoroscopy-guided percutaneous vertebroplasty in spinal malignancy: technical results, PMMA leakages, and complications in 202 patients.
abstract: OBJECTIVE
  To retrospectively evaluate the incidence and clinical impact of local polymethylmethacrylate (PMMA) leaks and pulmonary cement embolisms occurring under CT fluoroscopy-guided vertebroplasty of symptomatic malignant vertebral osteolyses.
  
  
  METHODS
  From December 2001 to June 2009, 202 cancer patients (116 women, 86 men; age 63.2±8.6 years) with painful malignant vertebral osteolyses underwent vertebroplasty, with or without vertebral compression fracture. A total of 331 vertebrae were treated in 231 sessions under CT fluoroscopy guidance (120 kV; 10–25 mA; single slice, 4-, 16-, and 128-row CT). In the pre-vertebroplasty CT, the following items were assessed: osteolytic destruction (0, ≤25, ≤50, ≤75, or ≤100%) of vertebral cross-sectional area, posterior wall, and circumference; presence of perivertebral and degree of epidural (no, mild, moderate) soft tissue involvement. Local PMMA leaks were analyzed using the post-vertebroplasty CT. Pulmonary cement embolisms were evaluated in all patients having undergone radiography (CR; n053) or CT (n088) of the chest after vertebroplasty due to their underlying disease. Patient charts were reviewed regarding adverse events.
  
  
  RESULTS
  Of 331 treated vertebrae, 32, 20.2, and 15.7% showed more than 50% osteolytic involvement of the vertebral cross-sectional area, posterior wall, and circumference, respectively. Mild or moderate epidural involvement was seen in 13.0 and 8.4%. Local PMMA leakage rate was 58.6% (194 of 331 vertebrae). Pulmonary cement embolisms (segmental, n010; central, n01) were seen after 7.8% of the procedures with follow-up imaging of the chest. No major complications occurred within a 30-day period after vertebroplasty.
  
  
  CONCLUSIONS
  Vertebroplasty of spinal malignancy can be safely performed under CT fluoroscopy guidance even in patients with substantial osteolytic involvement. In our patient collective, PMMA leaks and pulmonary cement embolisms visualized in post-procedural radiography and CT images had no clinical impact.
authors.affiliation: Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany. christoph.trumm@med.lmu.de
authors.forename: Christoph G
authors.initials: CG
authors.lastname: Trumm
authors.forename: Anne
authors.initials: A
authors.lastname: Pahl
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Helmberger
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Jakobs
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Zech
authors.forename: Robert
authors.initials: R
authors.lastname: Stahl
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Paprottka
authors.forename: Torleif A
authors.initials: TA
authors.lastname: Sandner
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Ralf-Thorsten
authors.initials: RT
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000453:epidemiology*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000453:epidemiology*; D019904:Polymethyl Methacrylate / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000601:surgery*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D019904:Polymethyl Methacrylate