Pathological compression fracture of thoracic spine with ...INTERVENTIONAL NEURORADIOLOGY!...
Transcript of Pathological compression fracture of thoracic spine with ...INTERVENTIONAL NEURORADIOLOGY!...
INTERVENTIONAL NEURORADIOLOGY
24/7 Contact & Appointment (310) 267-‐8761 or 8762
Pathological compression fracture of thoracic spine with partial loss of posterior wall
DIVISION OF INTERVENTIONAL NEURORADIOLOGY
Presents a patient case treated by the team members of the division
and physicians and staff of the UCLA Comprehensive Stroke Center
GARY DUCKWILER, MD Director and Professor
FERNANDO VINUELA, MD
Professor Emeritus
REZA JAHAN, MD Professor
SATOSHI TATESHIMA, MD, DMSc
Associate Professor
NESTOR GONZALEZ, MD Associate Professor
VIKTOR SZEDER, MD, PhD
Assistant Professor
PATIENT PRESENTATION
Figure 1: Severe wedge shaped compression fracture of T12 (white arrow)
• Late 30s female with history of breast cancer developed bone metastases including T12 (Fig.1).
• The T12 lytic bone metastasis caused compression fracture with 25% loss of height
• She suffered from uncontrollable pain from the fracture.
EVALUATION AND IMAGING
• Clear percussion tenderness over T12 spinous process.
• Based on imaging and clinical symptoms, her Spine Instability Neoplasic Score was nine (0 -‐18).
INTERVENTION PERFORMED
• Vertebral augmentation procedure (kyphoplasty) was performed via bi-‐pedicular access (Fig.2).
• Because of the lytic lesion, very thick cement (Xpede cement, Kyphone) was utilized.
Figure 2: Trans-‐pedicular access to T12 vertebral body and drilling the lesion. The entire procedure was done under conscious sedation and local anesthesia. No general anesthesia is necessary.
(over)
ICA
INTERVENTIONAL NEURORADIOLOGY
24/7 Contact & Appointment (310) 267-‐8761 or 8762
Procedures provided by DINR for adult and pediatric patients
Acute Ischemic Stroke
Acute Thrombectomy/Thrombolysis Extra/Intracranial Angioplasty/Stenting
Brain Hemorrhage, Aneurysm/AVM/fistulae
Aneurysm coiling Stent/balloon assisted aneurysm coiling Flow diverter stent device embolization
AVM/Dural fistulae embolization Venous Sinus Thrombectomy/Thrombolysis
Direct transcutaneous embolization
Chronic Occlusive Cerebrovascular Disease Extra/Intracranial Angioplasty/Stenting
Venous Sinus Angioplasty/Stenting
Head/neck/orbit tumors & vascular malformations, epistaxis
Endovascular embolization Direct percutaneous embolization
Division of Interventional Neuroradiology David Geffen School of Medicine at UCLA Ronald Reagan UCLA Medical Center 757 Westwood Plaza, Suite 2129 Los Angeles, CA 90095-‐7437 http://radiology.ucla.edu/site.cfm?id=217
KYPHOPLASTY BALLONS INFLATED
Division of Interventional Neuroradiology – A Leader in Neurovascular Care and Research • Invented the Merci retriever – the 1st endovascular device for acute stroke therapy • Invented GDC and Matrix coils – the leading tool for aneurysm treatment around the world • Developed Onyx liquid embolic material – the leading therapy for brain vascular malformations
Figure 3: Two kyphoplasty balloons were inserted into T12 vertebral body. Balloon inflation helps not just with regaining the height but also reduces chance of immature cement leakage to the spinal canal.
Figure 4: Kyphoplasty balloons were carefully inflated in T12 vertebral body. Also, we assured the patient neurological examination did not change.
THE OUTCOME
• The patient tolerated the procedure well without any complications. Her pain diminished dramatically after the procedure.
• Two weeks after the procedure, the patient no longer had the pain from fracture.
• In carefully selected patients, we can safely treat lytic vertebral compression fractures.
Figure 5: T12 lytic vertebral body metastasis was successfully treated with Kyphoplast with use of Xpede cement. (the dark color material in the vertebral body is the cement)
KYPHOPLASTY BALLONS PLACED