George S. Krol MD, Presenter: Nothing to Disclose

Eric Lis MD, Abstract Co-Author: Nothing to Disclose

To present and discuss the technical issues, iatrogenic complications and their clinical significance encountered during placement of canulas, inflation of balloon tamps and injection of PMMA cement in patients with vertebral metastases    

One hundred consecutive levels of vertebral augmentation (kyphoplasty/vertebroplasty) of the spine lesions proven metastatic on intraoperative biopsy were reviewed retrospectively for intraoperative "differencies from expected". These included: complications of instrumentation (incorrect needle path, posterior elements laceration or fracture, rupture of the endplate or cortex by the balloon and extraosseous leak of the cement. The evaluations were based on recent preoperative CT of the spine or abdomen and intraoperative CT and fluoroscopy.    

ISSUES: 1. Related to instrumentation: posterior elements  fractures - 2; inability to advance the canula into the target - 4; suboptimal placement of the canula - 3;  extra-vertebral expansion of the balloon - 3. 2. Related to PMMA injection: leak into regional vein - 47; distant travel of cement (lung) - 2; epidural extravasation - 5; leak into foramen - 3; leak into adjacent paraspinal soft tissues - 9; break into the disc space - 18. All procedures successfully completed, no focal neurological deficits postoperatively. 

PMMA augmentation of cancerous vertebrae often presents specific issues, arising from loss of landmarks for instrument guidance or boudaries for balloon/cement expansion, due to bone destruction. Careful preperative planning of needle trajectories, precise intraoperative instrumentation, use of tamps and closely monitored injection of cement is needed to achieve proper and safe placement of the cement.     

Because of loss of integrity, cancerous vertebrae present specific challanges in PMMA treatment, requiring thoughtful preoperative planning and careful intraoperative instrumentation. 

Krol, G, Lis, E, Challenges of Vertebral Augmentation in Patients with Cancer .  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013004.html