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Original research
Vertebral body stent augmentation to reconstruct the anterior column in neoplastic extreme osteolysis
  1. Alessandro Cianfoni1,2,
  2. Daniela Distefano1,
  3. Emanuele Pravatà1,
  4. Vittoria Espeli3,
  5. Gianfranco Pesce3,
  6. Pasquale Mordasini2,
  7. Luigi La Barbera4,
  8. Pietro Scarone5,
  9. Giuseppe Bonaldi6
  1. 1Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
  2. 2Department of Interventional and Diagnostic Neuroradiology, Inselspital, University Hospital of Bern, Bern, Switzerland
  3. 3Department of Neuro-oncology, Oncology Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
  4. 4Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
  5. 5Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
  6. 6Department of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
  1. Correspondence to Dr Daniela Distefano, Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, 6900, Lugano, Switzerland; daniela.distefano{at}eoc.ch

Abstract

Background Extensive lytic lesions of the vertebral body (VB) increase risk of fracture and instability and require stabilization of the anterior column. Vertebral augmentation is an accepted treatment option, but when osteolysis has extensively destroyed the VB cortical boundaries (a condition herein defined as ‘extreme osteolysis’), the risk of cement leakage and/or insufficient filling is high. Vertebral body stents (VBSs) might allow partial restoration of VB height, cement containment, and reinforcement, but their use in extreme osteolysis has not been investigated.

Objective To assess retrospectively the feasibility and safety of VBS augmentation in patients with ‘extreme osteolysis’ of the VB.

Methods We retrospectively analyzed 41 treated vertebrae (from T1 to L5). VB reconstruction was assessed on postprocedure CT images and rated on a qualitative 4-point scale (poor-fair-good-excellent). Clinical and radiological follow-up was performed at 1 month and thereafter at intervals in accordance with oncological protocols.

Results VBS augmentation was performed at 12 lumbar and 29 thoracic levels, with bilateral VBS in 23/41. VB reconstruction was judged satisfactory (good or excellent) in 37/41 (90%) of levels. Bilateral VBS received higher scores than unilateral (p=0.057, Pearson’s X2). We observed no periprocedural complications. Cement leaks (epidural or foraminal) occurred at 5/41 levels (12.2%) without clinical consequences. Follow-up data were available for 27/29 patients, extending beyond 6 months for 20 patients (7–28 months, mean 15.3 months). VBS implant stability was observed in 40/41 cases (97.5%).

Conclusions Our results support the use of VBS as a minimally invasive, safe and effective option for reconstructing the anterior column in prominent VB osteolysis.

  • neoplasm
  • spine
  • stent
  • metastatic

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Footnotes

  • Contributors All authors contributed to the presented work by substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work and drafting the work or revising it critically for important intellectual content and final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics committee of Canton Ticino.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published figures 2 and 3 have been switched. The legend of figure 3 has also been updated.

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