Interventional Spine

Bassem, Georgy, MD

Paper/Non-Mentor

Purpose

Percutaneous cement augmentation had been described for treatement of painful metastaic lesions of the spine and pelvic bones using standard Vertebroplasty systems usually with low viscosity cements have been associted with a higher percentage of leaks compared to benign fractures. The study was done to assess the safety, feasibility, and clinical outcome of using a higly viscous cement injected using a hydrolic based device in treatment of metastaic lesions of the spine and pelvis using flouroscopy and Computed Tomography guidance.

Methods & Materials

A series of 17 consecutively treated patients with different types of different primamry and secondry tumors were identified for the review. There were a total of 29 lesions treated. Levels treated ranged from C7 to L5, sacrum, ilium, and ischium.The degree of leakage was assessed at each treated level using a strict 4-point scale (none, minimal, moderate, severe). The pattern of any observed leakage was also characterized as: discal, venous, paravetebral, epidural, or SI joint. Cement leaks were assesed using both plain films and CT. Visual analog score (VAS) for pain was collected before the procedure and within 2-4 weeks after.

Results

On plain film there was no leak at 13, minimal at 9, and moderate at 2 levels. On CT there was no leak in 4, minimal at 15, and moderate at 2 levels. CT imaging identified 10 additional minimal leaks, but did not identify any additional moderate or severe leaks.
VAS pain data was available pre and post-procedure for 10 of 17 patients. The mean VAS pain score improved 49% from mean pre-op of 8.2 to a mean post-op VAS was 4.2.

Conclusion

Percutaneous cement augmentation of metastic lesions of the spine and pelvis is feasible and safe using a high viscosity cement system. A hydrolic injection device allow more control over the injected cement into a small caliber needles. Cement augmentation results in pain relief as measured by VAS with a 49% decrease in pain score.

References/Financial Disclosures

Consultant, DePuy Spine and Arthrocare Spine