title: Combining percutaneous pedicular and extrapedicular access for tumor ablation in a thoracic vertebral body.
abstract: We present a percutaneous modified technique to access large thoracic vertebral body lytic lesions, to increase the volume of tumor accessible to ablation, prior to cement augmentation. Tumor ablation and cavity creation-assisted percutaneous vertebroplasty was considered a palliative measure for structural stabilization in plasmocytoma involvement of the entire T8 vertebral body. Given the extent of osteolysis bilateral combined transpedicular and extrapedicular access to the vertebral body was undertaken to maximize the volume of cavity creation within the tumor. The combined transpedicular and extrapedicular access was feasible, uncomplicated, and successful in reaching all the quadrants of the anterior two thirds of the vertebral body. Slow, fluoroscopically monitored injection of high-viscosity cement resulted in a successful, desired cement distribution into the anterior two thirds of the vertebral body, spanning superior to inferior endplates, providing structural stability, in the absence of venous or epidural leakage. The technical modification described in this case yielded positive results while overcoming some of the limitations of the existing coblation device. This approach may offer an option for cement augmentation of extensive vertebral body lytic lesions, at increased risk for tumor displacement and extra-vertebral cement leakage.
authors.affiliation: Department of Neuroradiology, Medical University of South Carolina; Charleston, SC, USA - Department of Neuroradiology, Neurocenter of Italian Switzerland; Lugano, Switzerland - massarimd@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cianfoni
authors.affiliation: Department of Neuroradiology, Medical University of South Carolina; Charleston, SC, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Orthovita Inc.; Malvern, PA, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Ewing
authors.affiliation: Orthovita Inc.; Malvern, PA, USA.
authors.forename: Maarten
authors.initials: M
authors.lastname: Persenaire
authors.affiliation: Department of Neuroradiology, Medical University of South Carolina; Charleston, SC, USA.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Rumboldt
authors.affiliation: Neuroradiology Unit, Ospedali Riuniti di Bergamo; Bergamo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bonaldi
mesh_terms: D001416:Back Pain / Q000209:etiology; D001843:Bone Cements; D005471:Fluoroscopy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010954:Plasmacytoma / Q000000981:diagnostic imaging / Q000601:surgery*; D015641:Radiography, Interventional; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements
keywords: coblation; osteolytic lesion; plasmocytoma; spine tumor; tumor ablation; vertebroplasty