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Objective To study the application of transcatheter superselective arterial embolization for the spinal tumorectomy preopera-tive.Methods From January 2009 to September 2015,the data of 65 patients with spinal tumor were collected.Before operation,all the pa-tients had been performed the transcatheter superselective arterial embolization by Seldinger technology,the embolization effect and the blood loss volume were recorded.Results The pathological vertebral body of 62 patients were significantly dyed and the tumor-feeding artery were obvious.But no obvious tumor-feeding artery and the tumor dyeing was found in 3 cases.The tumor-feeding artery positive incidence of angi-ography was 95.3%(62/65).All cases intubation was successful but one.After embolization, the pathological vertebral body was removed completely.The blood loss volume was 500-3 000 mL,with an average (1 400.65 ±230.62) mL.Conclusion The transcatheter superse-lective arterial embolization could reduce the blood loss in spinal tumorectomy and the operation risks,and increase the possibilities of radical resection,which is an effective preoperative intervention.
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Objective To preliminarily evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) with 131I-loaded bone cement in treating vertebral tumor in rabbit models. Methods Twelve New Zealand white rabbits with lumbar vertebral tumor, which was established by puncturing transplant of VX2 carcinoma, were randomly and equally divided into the study group and the control group with 6 rabbits in each group. PVP with injection of 131I-loaded bone cement was carried out in the rabbits of the study group, while PVP with injection of pure bone cement was employed in the rabbits of the control group. The blood cell count was determined in all the animals one day before PVP as well as on the 4th day after PVP. PET-CT examination was performed one day before PVP as well as on the 4th day after PVP to check the stand uptake value (SUV) of each vertebral tumor. SPECT was performed in all rabbits of the study group at one, 4 and 8 days after PVP respectively to estimate the distribution of 131I in the animals’ bodies. Eight days after PVP, blood cell counts, which were determined both before and after PVP, existed between the study group and the control group. SPECT that was performed after PVP indicated that 131I was mainly accumulated within PVP-treated vertebrae, and the distribution of 131I showed no obvious changes at different points of time after the procedure. Before PVP, the difference in SUV between the two groups was of no statistical significance (F = 0.765, P > 0.05). In the study group, the postoperative SUV was significantly lower than the preoperative SUV (F = 423.792, P < 0.05). Pathological examination showed that the extent of tumor cell necrosis around the bone cement in the study group was remarkably bigger than that in the control group. Conclusion In treating vertebral tumors with PVP, the use of 131I-loaded bone cement is clinically feasible, and short-term follow-up indicates that this technique is safe and effective.
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Objective To investigate the temperature variation within intra-spinal canal and intra-spinal tumor during percutaneous radiofrequency ablation (RFA) procedure for vertebral tumor in experimental rabbits. Methods Eight New Zealand white rabbits were transplanted with VX2 carcinoma in the lumbar vertebral body by percutaneous puncture inoculation technique under CT guidance in order to set up vertebral tumor models. The eight vertebral tumor models were treated with RFA under CT guidance. The temperature within the spinal canal and vertebral tumor of rabbits was measured and recorded every 30 seconds during the RFA treatment. The results were statistically analyzed by paired sampled t text. Results The intra-tumor temperature rose to 90℃ rapidly and remained stable during the whole RFA procedure, whereas the temperature in the spinal canal exceeded 42℃ when treatment time was over three minutes during the procedure. Statistically significant difference in the temperature level during RFA existed between the spinal canal and the vertebral tumor (P < 0.05). Conclusion The temperature in the vertebral tumor of rabbit can quickly reach to the therapeutic level during RFA. Prolonging operative time of RFA may hurt the nerve due to high temperature.
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Complete vertebral tumor resection is important in order to prevent local recurrence. Among the available techniques for total spondylectomy, the total en bloc spondylectomy has been accepted as the most sophisticated one. After a total en bloc spondylectomy, anterior and posterior column reconstruction is mandatory in order to achieve stability. We experienced the usefulness of an expandable cage for anterior column reconstruction especially in this surgery. The chance of cutting the nerve root and damaging the spinal cord is minimized because the size of the expandable cage is initially small enough to be inserted into the anterior column. The technical details of total vertebral body replacement with an expandable cage after an en bloc lumbar spondylectomy are described herein.
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Recurrence , Spinal CordABSTRACT
[Objective]To report a new surgical technique of total en bloc spondylectomy for complete resection of primary spinal malignancy and for oncologic curability.The conventional approach for primary spinal malignancy is via intralesional piecemeal resection,and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins.[Method]Total en bloc spondylectomy,consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation,was performed in five patients with primary malignant tumors and two patients with giant cell tumors.Patients were observed for 2 years to 6.5 years,except for one patient who died 7 months after surgery because of mediastinal metastasis.[Result]All patients attained significant clinical improvement after surgery with no major complications except one.Histologically,the margins were wide or marginal except for the pedicles,and occasionally the spinal canal and the posterior,where they were accepted to be intralesional.One patient died of metastasis that was not directly related to surgery itself.There was no local recurrence.[Conclusion]The advantages of total en bloc spondylectomy include resection of the involved vertebra(e)in two major blocs,rather than in a piecemeal pattern,and completion of the procedure during one surgical session posteriorly.The"total en bloc spondylectomy"offers one of the most aggressive modes of therapy for primary spinal malignancy.
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Objective To discuss the clinical value of preoperative embolization of vertebral tumors. Methods Data of 54 patients were retrospectively studied. Thirteen lesions were in the cervical, 17 in the thoracic, 15 in the lumber and 9 in the sacral regions. The vertebral tumors were embolized prior to operation with gelatin sponge particles, polyvinyl alcohol (PVA) particles or coils. Surgical operations were performed within 1-7 days after the embolization. Results Totally 79 vessels of 43 patients were embolized, which included ascending cervical artery,1;vertebral artery,1;intercostal artery,39; lumber artery,19;internal iliac artery,15 and median sacral artery,4. Intraoperative hemorrhage showed a mean value of 1312 ml with range of 300-3000 ml in patients after embolization, and a mean value of 2375 ml with range of 1500-5000ml in patients without embolization at the same period(P