title: Vertebral augmentation for neoplastic lesions with posterior wall erosion and epidural mass.
abstract: OBJECTIVE
  The presence of a cortical erosion of the posterior wall or an epidural mass is commonly considered a contraindication to performing a vertebral augmentation, considering the perceived increased risk of an epidural cement leak. Our aim was to assess technical and clinical complications of vertebral augmentation procedures performed for pain palliation and/or stabilization of neoplastic lytic vertebral body lesions, with cortical erosion of the posterior wall, often associated with a soft-tissue epidural mass.
  
  
  METHODS
  In 48 patients, we performed retrospective vertebral augmentation assessment on 70 consecutive levels with cortical erosion of the posterior wall, as demonstrated by preprocedural CT/MR imaging. An epidural mass was present in 31/70 (44.3%) levels. Cavity creation was performed with Coblation Wands before cement injection in 59/70 levels. Injection of high-viscosity polymethylmethacrylate was performed under real-time continuous fluoroscopic control. Postprocedural CT of the treated levels was performed in all cases. Clinical follow-up was performed at 1 and 4 weeks postprocedurally.
  
  
  RESULTS
  In 65/70 (92.8%) levels, the vertebral augmentation resulted in satisfactory polymethylmethacrylate filling of the lytic cavity and adjacent trabecular spaces in the anterior half of the vertebral body. An epidural leak of polymethylmethacrylate occurred in 10/70 (14.2%) levels, causing radicular pain in 3 patients, which spontaneously resolved within 1 week in 2 patients, while 1 patient with a T1-T2 foraminal leak developed severe weakness of the intrinsic hand muscles and a permanent motor deficit.
  
  
  CONCLUSIONS
  In our series of vertebral augmentation of neoplastic lytic vertebral lesions performed for palliation of pain and/or stabilization, we observed a polymethylmethacrylate epidural leak in only 14.2% of levels, despite the presence of cortical erosion of the posterior wall and an epidural mass, with an extremely low rate of clinical complications. Our data seem to justify use of vertebral augmentation in patients with intractable pain or those at risk for vertebral collapse.
authors.affiliation: From the Departments of Neuroradiology (A.C., E.R.).
authors.forename: A
authors.initials: A
authors.lastname: Cianfoni
authors.affiliation: From the Departments of Neuroradiology (A.C., E.R.) Department of Radiology (E.R.) New York University Langone Medical Center, New York, New York Department of Neurology and Psychiatry (E.R.), Sapienza University of Rome, Rome, Italy eytan.raz@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Raz
authors.affiliation: Oncology Institute of Italian Switzerland (S.M., S.D.L., G.P.), Bellinzona, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Mauri
authors.affiliation: Oncology Institute of Italian Switzerland (S.M., S.D.L., G.P.), Bellinzona, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Di Lascio
authors.affiliation: Neurosurgery (M.R.), Neurocenter of Southern Switzerland, Lugano, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Reinert
authors.affiliation: Oncology Institute of Italian Switzerland (S.M., S.D.L., G.P.), Bellinzona, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Pesce
authors.affiliation: Department of Neuroradiology (G.B.), Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bonaldi
mesh_terms: D000328:Adult; D001843:Bone Cements / Q000627:therapeutic use; D004824:Epidural Space / Q000473:pathology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery; D013125:Spinal Neoplasms / Q000473:pathology* / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate