P16.05 Percutaneous vertebral body stenting to restore stability of the anterior column in extreme spinal osteolysis

• Published in: Neuro-oncology (Charlottesville, Va.) Vol. 19; no. suppl_3; p. iii110
• Main Authors: Cianfoni, A., Distefano, D., Espeli, V., Bonaldi, G., Scarone, P., Pesce, G.
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.05.2017
• Subjects: POSTER PRESENTATIONS
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/nox036.421

Introduction: Extreme neoplastic osteolysis of the vertebral body (VB) determines risk of collapse and instability. The current treatment of extensive VB lesions aims to restore stability with instrumentation generally performed with a combined, anterior and posterior, surgical approach. The anterior part of this operation carries significant morbidity related to its invasiveness, long hospitalization and high complication rate. Percutaneous vertebral augmentation is a palliative treatment of painful or at-risk of- collapse lytic VB lesions, but osteolysis with wide cortical involvement has higher risk of cement leakage, possibly limiting the amount of cement injected, resulting in insufficient stabilization. Vertebral body stent (VBS) is a barrel-shaped semi-rigid implant with large support surface, that can be inserted with a percutaneous image-guided minimally invasive technique, and allows primary stabilization of anterior column and cement containment. The aim of our work was to assess technical and clinical results and complications of a procedure of kyphoplasty with VBS for pain palliation and spinal stabilization in selected patients with extreme lytic VB lesions. Materials and Methods: retrospective review of a prospectively maintained database of 29 consecutive patients with extensive neoplastic osteolysis (>2/3 of the VB with erosion of the cortical boundaries) in one or more VB, from T1 to S1, for a total of 42 spinal levels, treated with kyphoplasty and VBS between March 2013 and September 2016. All target lesions presented morphological criteria of instability based on SINS and/or Taneichi criteria. Post-procedural CT images were reviewed in consensus by two neuroradiologists and one neurosurgeon to assess the correct placement of the devices and the cement filling of the lytic cavities, to evaluate the results in terms of restoration of VB height, stabilization of the target level, and to detect technical complication. Clinical and radiological follow-up was performed at 30 days and patients were followed up clinically and radiologically as per oncology clinical practice. Follow-up ranges between 1 and 24 months. Results: The procedure was deemed technically successful in providing structural stability in 40/42 cases. Epidural or foraminal leaks of cement occurred in 5/42 levels without clinical consequences. In 1 case there was an anterior mobilization of the stents with onset of dysphagia, at 30 days, that gradually resolved, with no further implant mobilization at 3 months. Pain reduction was attributable to the procedure itself in 19 cases, in combination with radiation and/or chemotherapy in 6, while 4 patients reported no significant pain amelioration. Conclusions: Our preliminary results support the use of kyphoplasty with VBS as an effective and safe procedure to restore stability and reduce pain in selected patients with extreme spinal osteolysis.