Change in the cross-sectional area of the thecal sac following balloon kyphoplasty for pathological vertebral compression fractures prior to spine stereotactic radiosurgery Journal Article


Authors: Lis, E.; Laufer, I.; Barzilai, O.; Yamada, Y.; Karimi, S.; McLaughlin, L.; Krol, G.; Bilsky, M. H.
Article Title: Change in the cross-sectional area of the thecal sac following balloon kyphoplasty for pathological vertebral compression fractures prior to spine stereotactic radiosurgery
Abstract: OBJECTIVE Percutaneous vertebral augmentation procedures such as vertebroplasty and kyphoplasty are often performed in cancer patients to relieve mechanical axial-load pain due to pathological collapse deformities. The collapsed vertebrae in these patients can be associated with varying degrees of spinal canal compromise that can be worsened by kyphoplasty. In this study the authors evaluated changes to the spinal canal, in particular the cross-sectional area of the thecal sac, following balloon kyphoplasty (BKP) prior to stereotactic radiosurgery (SRS). METHODS The authors retrospectively reviewed the records of all patients with symptomatic vertebral compression fractures caused by metastatic disease who underwent kyphoplasty prior to single-fraction SRS. The pre-BKP cross-sectional image, usually MRI, was compared to the post-BKP CT myelogram required for radiation treatment planning. The cross-sectional area of the thecal sac was calculated pre- and postkyphoplasty, and intraprocedural CT imaging was reviewed for epidural displacement of bone fragments, tumor, or polymethylmethacrylate (PMMA) extravasation. The postkyphoplasty imaging was also evaluated for evidence of fracture progression or fracture reduction. RESULTS Among 30 consecutive patients, 41 vertebral levels were treated with kyphoplasty, and 24% (10/41) of the augmented levels showed a decreased cross-sectional area of the thecal sac. All 10 of these vertebral levels had preexisting epidural disease and destruction of the posterior vertebral body cortex. No bone fragments were displaced posteriorly. Minor epidural PMMA extravasation occurred in 20% (8/41) of the augmented levels but was present in only 1 of the 10 vertebral segments that showed a decreased cross-sectional area of the thecal sac postkyphoplasty. CONCLUSIONS In patients with preexisting epidural disease and destruction of the posterior vertebral body cortex who are undergoing BKP for pathological fractures, there is an increased risk of further mass effect upon the thecal sac and the potential to alter the SRS treatment planning.
Keywords: oncology; metastases; spine metastasis; kyphoplasty; epidural disease; cement augmentation
Journal Title: Journal of Neurosurgery
Volume: 30
Issue: 1
ISSN: 0022-3085
Publisher: American Association of Neurological Surgeons  
Date Published: 2019-01-01
Start Page: 111
End Page: 118
Language: English
ACCESSION: WOS:000454623600014
DOI: 10.3171/2018.6.Spine18206
PROVIDER: wos
PUBMED: 30497230
Notes: Article -- Source: Wos
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MSK Authors
  1. Eric Lis
    102 Lis
  2. Yoshiya Yamada
    357 Yamada
  3. Mark H Bilsky
    220 Bilsky
  4. Sasan Karimi
    97 Karimi
  5. George Krol
    32 Krol
  6. Ilya Laufer
    97 Laufer