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Percutaneous Cement Augmentation for Malignant Lesions: Metastases and Multiple Myeloma

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Image Guided Interventions of the Spine

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Abstract

Spinal compression fractures secondary to metastatic tumors or multiple myeloma can result in debilitating mechanical back pain. Percutaneous cement augmentation is a minimally invasive technique that can provide spinal stability, as well as pain relief. This is performed through percutaneous cannulation of the fractured vertebral body (VB), most commonly through a posterior approach, followed by injection of cement. Various types of bone cement have been used for augmentation, with polymethyl methacrylate (PMMA) being the most commonly used. Indications for cement augmentation include an acute or non-healed compression fracture that corresponds to a site of mechanical back pain. Anatomical considerations must be taken into account to ensure the VB may be safely cannulated and that cement can be applied with a low risk of extravasation. The risk of extravasation has been related to the type of augmentation performed, depending on whether cement is directly injected into the VB after cannulation or following cavity creation with a balloon bone tamp or navigating osteotome. The most common complication encountered is cement extravasation outside of the VB. Although the vast majority of extravasation events are asymptomatic, the most potentially concerning incidences are extravasation posteriorly into the spinal canal or intravascular extravasation, which have resulted in rare instances of pulmonary or cardiac embolism.

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Author information

Authors and Affiliations

  1. Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA

    James K. C. Liu

  2. Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA

    Sergiy V. Kushchayev & John A. Arrington

Authors
  1. James K. C. Liu
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  2. Sergiy V. Kushchayev
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  3. John A. Arrington
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Corresponding author

Correspondence to James K. C. Liu .

Editor information

Editors and Affiliations

  1. Thomas Jefferson University, Philadelphia, PA, USA

    Majid Khan

  2. Moffitt Cancer Center, Tampa, FL, USA

    Sergiy V. Kushchayev

  3. Thomas Jefferson University, Philadelphia, PA, USA

    Scott H. Faro

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Liu, J.K.C., Kushchayev, S.V., Arrington, J.A. (2021). Percutaneous Cement Augmentation for Malignant Lesions: Metastases and Multiple Myeloma. In: Khan, M., Kushchayev, S.V., Faro, S.H. (eds) Image Guided Interventions of the Spine. Springer, Cham. https://doi.org/10.1007/978-3-030-80079-6_13

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  • DOI: https://doi.org/10.1007/978-3-030-80079-6_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-80078-9

  • Online ISBN: 978-3-030-80079-6

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