title: Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease.
abstract: Balloon kyphoplasty (BKP) has been proven to be safe and effective in the management of pathological vertebral compression fracture (VCF) due to metastatic spinal disease. The most common serious complications related to BKP include cement extravasation and new fractures at adjacent levels. Although the potential for "tumor extravasation" has been discussed as a potential iatrogenic complication, it has yet to be confirmed. The authors report on 2 cases of tumor extravasation following BKP, which they base on an observed unusual rapid tumor spread pattern into the adjacent tissues. They postulate that by increasing the vertebral body internal pressure and disrupting the tissues during balloon inflation and cement application, a soft-tissue tumor can be forced beyond the vertebral bony boundaries through pathological cortical defects. This phenomenon can manifest radiologically as subligamentous spread and/or extension into venous sinusoids, resulting in epidural venous plexus involvement, with subsequent tumor migration into the adjacent vertebral segments. Accordingly, the authors advise caution in using BKP when significant epidural tumor is present. The complication they encountered has caused them to modify their preference such that they now first use radiosurgery and subsequently BKP to ensure the target is appropriately treated, and they are currently developing possible modifications of procedural technique to reduce the risk.
authors.affiliation: Department of Medical Imaging, Toronto Western Hospital, University of Toronto;
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Cruz
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.forename: Cari
authors.initials: C
authors.lastname: Whyne
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Roger
authors.initials: R
authors.lastname: Smith
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D016103:Spinal Fractures / Q000601:surgery*; D013125:Spinal Neoplasms / Q000473:pathology* / Q000556:secondary*; D013904:Thoracic Vertebrae / Q000601:surgery
chemical_list: D001843:Bone Cements
keywords: BKP = balloon kyphoplasty; SRS = stereotactic radiosurgery; VCF = vertebral compression fracture; balloon kyphoplasty; metastatic disease; oncology; pathological vertebral compression fracture; tumor extravasation; tumor spread