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Background and Purpose: 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., Materials and 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., (© 2015 by American Journal of Neuroradiology.)

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.

This report describes a case of successful percutaneous direct-puncture ethanol embolization, followed by vertebroplasty, of an aggressive vertebral hemangioma (VH) involving two adjacent thoracic vertebral levels. In this case, the 78-year-old male patient presented with a 6-month history of progressive paraparesis due to spinal cord compression by a T8-T9 VH with an extensive epidural component. Follow-up demonstrated epidural component shrinkage with complete regression of symptoms at 3 months. This case suggests that exclusive percutaneous treatment may be considered for symptomatic VH even when two adjacent vertebral levels are affected., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Purpose: The purpose of this study was to prospectively evaluate results and complications of percutaneous vertebroplasty (PV) performed in 6 different Italian Centres belonging to the European VErtebroplasty RESearch Team (E.VE.RES.T) in a large series of patients., Materials and Methods: Follow-up was obtained in 4547 patients (3211 females and 1336 males; mean age 70.2 years) that underwent PV for a total of 13.437 treated vertebrae. Procedures were performed by using fluoroscopic guidance or combined CT-fluoroscopic guidance. All patients underwent PV in local anaesthesia except for second cervical vertebrae treated with a trans-oral approach that required general anaesthesia., Results: 4004 out of 4547 (88.0%) patients reported significant pain relief (difference>or=2 point in pain evaluated with an 11-point visual analogue scale; p<0.0001) within 48 h: an average of 7.7 ± 0.4 dropped to 1.8 ± 0.6 in the osteoporotic patients; 8.3 ± 0.4 to 2.4 ± 0.4 in metastases; 8.3 ± 0.4 to 1.7 ± 1.0 in myeloma; 6.2 ± 3.5 to 0.3 ± 0.2 in angioma and 7.4 ± 0.4 to 1.4 ± 0.9 in trauma. 430 osteoporotic patients (13%) were retreated for a subsequent fracture; in 302/430 patients (70.2%), the new fracture occurred in the contiguous vertebra. No major neurologic complications were reported and the most frequent minor complication was venous leakage (20.5%)., Conclusions: This large series of patients confirms that percutaneous vertebroplasty is an effective and safe procedure in the treatment of vertebral fractures. Best results are obtained in the treatment of myeloma and trauma., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background Context: Percutaneous vertebroplasty (PV) can provide pain relief and biomechanical stabilization of lytic metastasis of the spine in selected patients. Percutaneous vertebroplasty of the atlas has been reported in only five cases and has been performed with different techniques and approaches., Purpose: To describe the technique we used to perform PV of a lytic lesion of the lateral mass of C1 under computed tomography, computed tomography angiography, and computed tomography fluoroscopy guidance with a posterolateral approach, sparing the vertebral artery (VA)., Study Design/setting: Technical note., Methods: A 36-year-old woman with a history of intestinal carcinoid tumor presented with neck pain refractory to medical treatment. Radiological evaluation showed osteolytic destruction of the left lateral mass of the atlas, at the risk of collapse, with erosion of the VA canal. Under computed tomography and computed tomography angiography guidance, a percutaneous posterolateral oblique approach to the C1 left lateral mass was performed followed by cement augmentation under computed tomography fluoroscopy control., Results: Complete cement filling of the osteolytic lesion was achieved. A cement leak was noted along the horizontal V3 segment of the left VA. Computed tomography angiography scan showed patency of the VA after the procedure. There were no clinical complications. The patient reported substantial pain relief and improved range of motion at 12 hours postprocedure, which remained stable at 2-month follow-up examination., Conclusions: Computed tomography-guided PV of C1 lytic lesion with posterolateral approach was effective in the described case for pain control and stabilization, and it may be a therapeutic option in selected patients to avoid occipitocervical fusion. This procedure requires good understanding of the anatomy and rigorous technique to avoid potential complications., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background and Purpose: Interspinous spacers are implanted to treat symptomatic lumbar stenosis. Posterior vertebral element fractures can occur during or after interspinous spacer implants, especially in patients with osteopenia. The purpose of our study was to assess the biomechanical rationale, safety, feasibility, and effectiveness of posterior vertebral arch cement augmentation (spinoplasty) in preventing delayed spinous process fractures after interspinous spacer implants in patients with risk factors for fragility fractures., Materials and Methods: We performed a nonrandomized historically controlled clinical trial. From June 2007 to March 2010, we implanted interspinous spacers in 35 eligible patients with fragility-fracture risk factors. In 19/35 patients treated after April 2009, after we assessed the theoretic biomechanical effects of cement augmentation of the spinous process and laminae by FEM, a percutaneous spinoplasty was also performed. Clinical and radiologic follow-up ranged between 12 and 36 months after the intervention., Results: No intraprocedural spinous process fractures were observed in either group, and no patients in the 24-hour postoperative period had complications that were procedure-related. Symptomatic delayed spinous process fractures were diagnosed in 4/16 patients who did not undergo spinoplasty (25.0%), while no fractures were diagnosed in the 19 treated patients (P = .035)., Conclusions: Spinoplasty is feasible and safe. It has a biomechanical rationale, as demonstrated by an FEM. In our preliminary experience, it seems effective in preventing delayed fractures of the posterior arch post-interspinous spacer placement in patients at risk for fragility fractures. These patients have a significant risk of developing a symptomatic delayed spinous process fracture if not treated with spinoplasty.

Percutaneous vertebroplasty and kyphoplasty are procedures used to treat pain associated with vertebral compression fractures. Controversies are still open regarding indications, efficacy and safety of the procedures, and regarding the potential benefits, advantages and shortcomings of PV versus KP.Aim of this article is to report 7 years' experience in vertebral augmentation of the E.VE.RES.T. (European VErtebroplasty RESearch Team) group. The main topics are the treatments of hemangioma and malignant lesions, technically challenging cases such as vertebra plana, multifragmented fractures, multilevel treatments, refracture of augmented vertebra, and treatment of cervical junction and sacrum.