Metastatic Lesions Affecting the Spine

Neoplastic and metastatic lesions can involve the vertebral bodies as well as intra- and extramedullary structures. The goal of endovascular treatment remains devascularization prior to a planned surgery or biopsy (Figure 16.7). Embolization significantly reduces the blood loss and improves the surgical resection.34-37 Because the embolization is performed with Gelfoam, PVA, or on some occasions with dehydrated ethanol, attention has to be paid to the potential supply of radiculomedullary/radiculopial arteries to the anterior or posterior spinal arteries. An embolization can on rare occasion lead to tumor necrosis, with subsequent swelling and spinal cord compression. Preprocedural high-dose corticosteroid medication has been suggested.38 On rare occasions and in nonsurgical patients, embolization can be helpful for pain reduction and treatment of radicular compression.38 Although a reduction of tumor growth may be seen, embolization for spinal metastasis and malignant spinal tumors is not curative.

An endovascular or direct percutaneous embolization of a vertebral body metastasis or malignant tumor can be achieved. The latter can be performed under CT or fluoroscopic guidance,39 with the use of NBCA, PMMA, or dehydrated ethanol.40 41 Use of PMMA can additionally import biomechanical stability to the vertebral body.42 The percutaneous approach to treatment of spinal metastases can also employ radio-frequency ablation (RFA) with or without the use of PMMA (poly-methylmethacrylate).

Radio Freq Ablation Spine

Figure 16.6. Spinal images of an 11-year-old boy who presented with intractable neck pain associated with an aneurysmal bone cyst after a football match. A pre-operative transarterial PVA em-bolization was performed. (A) Lateral plain spine x-ray film shows a sharply demarcated os-teolytic lesion of the posterior part of the C5 vertebral body (arrow) and narrowing of the spinal canal. (B) T1-weighted image shows the C5 lesion with well-defined calcified boundaries (arrow). There is no epidural extension or spinal cord compression visible.

Figure 16.6. Continued. (C) Contrast-enhanced CT image shows a hypodense lesion (arrow) with enhancement of the margins. Note the involvement of the vertebral and neuronal foramina and extension into the lateral recess. (D) Selective right vertebral artery an-giogram (lateral plane) shows tortuous feeding posterior and lateral somatic branches arising from two major supplying radicular arteries (arrows); moderate vascularity with a rich network of dilated and tortuous feeding vessels, and patchy collections of contrast material in the cystic spaces, persisting into the late venous phase (see E). (E) Late arterial (lateral plane) phase shows the prominent filling of the epidural venous network and depicts the persisting blush of the C5 vertebral body (arrows).

Metastatic Lesion Spine Images Vertebral Hemangioma Vertebral Body

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Essentials of Human Physiology

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