Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation.

Piechowiak, Eike I.; Isalberti, Maurizio; Pileggi, Marco; Distefano, Daniela; Hirsch, Joshua A; Cianfoni, Alessandro (2019). Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation. Medicina, 55(10) MDPI 10.3390/medicina55100633

[img]
Preview
Text
medicina.pdf
Available under License Creative Commons: Attribution (CC-BY).

Download (1MB) | Preview

Background and Objectives: We describe a novel technique for percutaneous tumor debulking and cavity creation in patients with extensive lytic lesions of the vertebral body including posterior wall dehiscence prior to vertebral augmentation (VA) procedures. The mechanical cavity is created with a combination of curettage and vacuum suction (Q-VAC). Balloon kyphoplasty and vertebral body stenting are used to treat neoplastic vertebral lesions and might reduce the rate of cement leakage, especially in presence of posterior wall dehiscence. However, these techniques could theoretically lead to increased intravertebral pressure during balloon inflation with possible mobilization of soft tissue tumor through the posterior wall, aggravation of spinal stenosis, and resultant complications. Creation of a void or cavity prior to balloon expansion and/or cement injection would potentially reduce these risks. Materials and Methods: A curette is coaxially inserted in the vertebral body via transpedicular access trocars. The intravertebral neoplastic soft tissue is fragmented by multiple rotational and translational movements. Subsequently, vacuum aspiration is applied via one of two 10 G cannulas that had been introduced directly into the fragmented lesion, while saline is passively flushed via the contralateral cannula, with lavage of the fragmented solid and fluid-necrotic tumor parts. Results: We applied the Q-VAC technique to 35 cases of thoracic and lumbar extreme osteolysis with epidural mass before vertebral body stenting (VBS) cement augmentation. We observed extravertebral cement leakage on postoperative CT in 34% of cases, but with no clinical consequences. No patients experienced periprocedural respiratory problems or new or worsening neurological deficit. Conclusion: The Q-VAC technique, combining mechanical curettage and vacuum suction, is a safe, inexpensive, and reliable method for percutaneous intravertebral tumor debulking and cavitation prior to VA. We propose the Q-VAC technique for cases with extensive neoplastic osteolysis, especially if cortical boundaries of the posterior wall are dehiscent and an epidural soft tissue mass is present.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Piechowiak, Eike Immo and Cianfoni, Alessandro

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1648-9144

Publisher:

MDPI

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

15 Jun 2020 12:30

Last Modified:

16 Jun 2020 04:21

Publisher DOI:

10.3390/medicina55100633

PubMed ID:

31554335

Uncontrolled Keywords:

cavity creation lytic vertebral body lesions vertebral augmentation vertebral body stent

BORIS DOI:

10.7892/boris.144391

URI:

https://boris.unibe.ch/id/eprint/144391

Actions (login required)

Edit item Edit item
Provide Feedback