Skip to main content
SpringerLink
Log in

Embolisation, Vertebroplasty and Chemonucleolysis of Spinal Lesions

  • Chapter
  • First Online:
Tutorials in Endovascular Neurosurgery and Interventional Neuroradiology

  • 1849 Accesses

Abstract

Embolisation is generally not curative for spinal tumours but may reduce mass effect and improve symptoms. Treatments may involve embolisation or sclerotherapy delivered transarterially or after percutaneous puncture of tumour vessels. It is a useful preoperative procedure because haemostasis can be difficult at surgery with vascular structures often inaccessible at the early stages of a resection operation. Surgery is performed for patients with lesions causing neurological deficits. As with the other procedures described in this tutorial, management decisions should be made in multidisciplinary discussions, and if surgery is the most appropriate primary treatment, preoperative embolisation should always be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Nguyen JP, Djindjian M, Gaston A, Gherardi R, Benhaiem N, Caron JP, Poirier J. Vertebral hemangiomas presenting with neurologic symptoms. Surg Neurol. 1987;27(4):391–7.

    Article  PubMed  CAS  Google Scholar 

  2. Lee S, Hadlow AT. Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression. Spine (Phila Pa 1976). 1999;24(20):2111–4.

    Article  CAS  Google Scholar 

  3. Djindjian R, Merland JJ, Djindjian M, Steoter P. Angiography of spinal column and spinal cord tumours. Neuroradiology Atlas. New York: Thieme; 1981.

    Google Scholar 

  4. Ross JS, Masaryk TJ, Modic MT, Carter JR, Mapstone T, Dengel FH. Vertebral hemangiomas: MR imaging. Radiology. 1987;165(1):165–9.

    PubMed  CAS  Google Scholar 

  5. Hekster RE, Luyendijk W, Tan TI. Spinal-cord compression caused by vertebral haemangioma relieved by percutaneous catheter embolisation. Neuroradiology. 1972;3(3):160–4.

    Article  PubMed  CAS  Google Scholar 

  6. Ng VW, Clifton A, Moore AJ. Preoperative endovascular embolisation of a vertebral haemangioma. J Bone Joint Surg Br. 1997;79-B:808–11.

    Article  Google Scholar 

  7. Jayakumar PN, Vasudev MK, Srikanth SG. Symptomatic vertebral haemangioma: endovascular treatment of 12 patients. Spinal Cord. 1997;35(9):624–8.

    Article  PubMed  CAS  Google Scholar 

  8. Doppman JL, Oldfield EH, Heiss JD. Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol. Radiology. 2000;214(2):341–8.

    PubMed  CAS  Google Scholar 

  9. Ide C, Gangi A, Rimmelin A, Beaujeux R, Maitrot D, Buchheit F, Sellal F, Dietemann JL. Vertebral haemangiomas with spinal cord compression: the place of preoperative percutaneous vertebroplasty with methyl methacrylate. Neuroradiology. 1996;38(6):585–9.

    Article  PubMed  CAS  Google Scholar 

  10. Raco A, Ciappetta P, Artico M, Salvati M, Giulio Guidetti G, Guglielmi G. Vertebral hemangiomas with cord compression: the role of embolization in five cases. Surg Neurol. 1990;34(3):164–8.

    Article  PubMed  CAS  Google Scholar 

  11. Goyal M, Mishra NK, Sharma A, Gaikwad SB, Mohanty BK, Sharma S. Alcohol ablation of symptomatic vertebral hemangiomas. AJNR Am J Neuroradiol. 1999;20(6):1091–6.

    PubMed  CAS  Google Scholar 

  12. Guelbenzu S, Gomez J, Garcia-Asensio S, Barrena R, Ferrandez D. Preoperative percutaneous++ vertebroplasty in hemangioma compression. Rev Neurol. 1999;28(4):397–400.

    PubMed  CAS  Google Scholar 

  13. Asthana AK, Tandon SC, Pant GC, Srivastava A, Pradhan S. Radiation therapy for symptomatic vertebral hemangioma. Clin Oncol. 1990;2:159–62.

    Article  CAS  Google Scholar 

  14. Sakata K, Hareyama M, Oouchi A, Sido M, Nagakura H, Tamakawa M, Akiba H, Morita K. Radiotherapy of vertebral hemangiomas. Acta Oncol. 1997;36(7):719–24.

    Article  PubMed  CAS  Google Scholar 

  15. Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer. 1992;69(12):2921–31.

    Article  PubMed  CAS  Google Scholar 

  16. Papagelopoulos PJ, Currier BL, Shaughnessy WJ, Sim FH, Ebsersold MJ, Bond JR, Unni KK. Aneurysmal bone cyst of the spine. Management and outcome. Spine (Phila Pa 1976). 1998;23(5):621–8.

    Article  CAS  Google Scholar 

  17. Munk PL, Helms CA, Holt RG, Johnston J, Steinbach L, Neumann C. MR imaging of aneurysmal bone cysts. AJR Am J Roentgenol. 1989;153(1):99–101.

    PubMed  CAS  Google Scholar 

  18. De Cristofaro R, Biagini R, Boriani S, Ricci S, Ruggieri P, Rossi G, Fabbri N, Roversi R. Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone. Skeletal Radiol. 1992;21(8):523–7.

    Article  PubMed  Google Scholar 

  19. Guibaud L, Herbreteau D, Dubois J, Stempfle N, Bérard J, Pracros JP, Merland JJ. Aneurysmal bone cysts: percutaneous embolization with an alcoholic solution of zein – series of 18 cases. Radiology. 1998;208(2):369–73.

    PubMed  CAS  Google Scholar 

  20. Szendroi M, Antal I, Liska GY, Konya A. Calcitonin therapy of aneurysmal bone cysts. J Cancer Res Clin Oncol. 1992;119:61–5.

    Article  PubMed  CAS  Google Scholar 

  21. Bush CH, Drane WE. Treatment of an aneurysmal bone cyst of the spine by radionuclide ablation. AJNR Am J Neuroradiol. 2000;21(3):592–4.

    PubMed  CAS  Google Scholar 

  22. Nemoto O, Moser Jr RP, Van Dam BE, Aoki J, Gilkey FW. Osteoblastoma of the spine. A review of 75 cases. Spine (Phila Pa 1976). 1990;15(12):1272–80.

    Article  CAS  Google Scholar 

  23. Frassica FJ, Waltrip RL, Sponseller PD, Ma LD, McCarthy Jr EF. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am. 1996;27(3):559–74.

    PubMed  CAS  Google Scholar 

  24. Donkol RH, Al-Nammi A, Moghazi K. Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children. Pediatr Radiol. 2008;38(2):180–5.

    Article  PubMed  Google Scholar 

  25. Towbin R, Kaye R, Meza MP, Pollock AN, Yaw K, Moreland M. Osteoid osteoma: percutaneous excision using a CT-guided coaxial technique. AJR Am J Roentgenol. 1995;164(4):945–9.

    PubMed  CAS  Google Scholar 

  26. Roger B, Bellin MF, Wioland M, Grenier P. Osteoid osteoma: CT-guided percutaneous excision confirmed with immediate follow-up scintigraphy in 16 outpatients. Radiology. 1996;201(1):239–42.

    PubMed  CAS  Google Scholar 

  27. Shi HB, Suh DC, Lee HK, Lim SM, Kim DH, Choi CG, Lee CS, Rhim SC. Preoperative transarterial embolization of spinal tumor: embolization techniques and results. AJNR Am J Neuroradiol. 1999;20(10):2009–15.

    PubMed  CAS  Google Scholar 

  28. Baker KB, Moran CJ, Wippold 2nd FJ, Smirniotopoulos JG, Rodriguez FJ, Meyers SP, Siegal TL. MR imaging of spinal hemangioblastomas. AJR Am J Roentgenol. 2000;174:377–82.

    PubMed  CAS  Google Scholar 

  29. Vazquez-Anon V, Botella C, Beltran A, Solera M, Piquer J. Pre-operative embolization of solid cervicomedullary junction hemangioblastomas: report of two cases. Neuroradiology. 1997;39:86–9.

    Article  PubMed  CAS  Google Scholar 

  30. Tampieri D, Leblanc R, TerBrugge K. Preoperative embolization of brain and spinal hemangioblastomas. Neurosurgery. 1993;33(3):502–5; discussion 505.

    Article  PubMed  CAS  Google Scholar 

  31. Biondi A, Ricciardi GK, Faillot T, Capelle L, Van Effenterre R, Chiras J. Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature. AJNR Am J Neuroradiol. 2005;26(4):936–45.

    PubMed  Google Scholar 

  32. Gellad FE, Sadato N, Numaguchi Y, Levine AM. Vascular metastatic lesions of the spine: preoperative embolization. Radiology. 1990;176(3):683–6.

    PubMed  CAS  Google Scholar 

  33. Smit JW, Vielvoye GJ, Goslings BM. Embolization for vertebral metastases of follicular thyroid car­cinoma. J Clin Endocrinol Metab. 2000;85(3):989–94.

    Article  PubMed  CAS  Google Scholar 

  34. Bascoulergue Y, Duquesnel J, Leclercq R, Mottolese C, Lapras C. Percutaneous injection of methyl methacrylate in the vertebral body for the treatment of various diseases: percutaneous vertebroplasty. Radiology. 1988;169:372.

    Google Scholar 

  35. Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):166–8.

    PubMed  CAS  Google Scholar 

  36. Bostrom MPG, Lane JM. Future directions. Augmentation of osteoporotic vertebral bodies. Spine. 1997;22(24S):38S–42S.

    Article  PubMed  CAS  Google Scholar 

  37. Belkoff SM, Mathis JM, Erbe EM, Fenton DC. Biomechanical evaluation of a new bone cement for use in vertebroplasty. Spine. 2000;25:1061–4.

    Article  PubMed  CAS  Google Scholar 

  38. Cortet B, Cotton A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, et al. Percutaneous vertebroplasty in the treatment of osteoporotic compression fractures: an open prospective study. J Rheumatol. 1999;26(10):2222–8.

    PubMed  CAS  Google Scholar 

  39. Murphy KJ, Deramond H. Percutaneous vertebroplasty in benign and malignant disease. Neuroimaging Clin N Am. 2000;10(3):535–45.

    PubMed  CAS  Google Scholar 

  40. Jenson ME, Dion JE. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997;18:1897–904.

    Google Scholar 

  41. Daimond TH, Bryant C, Browne L, Clark WA. Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust. 2006;184:113–7.

    Google Scholar 

  42. Deramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am. 1998;36:533–46.

    Article  PubMed  CAS  Google Scholar 

  43. Parisien RC, Ball PA. William Jason Mixter (1880–1958). Ushering in the “dynasty of the disc”. Spine (Phila Pa 1976). 1998;23(21):2363–6.

    Article  CAS  Google Scholar 

  44. Smith L. Enzyme dissolution of nucleus pulposus in humans. JAMA. 1964;187:137–40.

    Article  PubMed  CAS  Google Scholar 

  45. Javid MJ, Nordby EJ, Ford LT, Hejna WJ, Whisler WW, Burton C, Millett DK, Wiltse LL, Widell Jr EH, Boyd RJ, Newton SE, Thisted R. Safety and efficacy of chymopapain (Chymodiactin) in herniated nucleus pulposus with sciatica. Results of a randomized, double-blind study. JAMA. 1983;249(18):2489–94.

    Article  PubMed  CAS  Google Scholar 

  46. Takahashi T, Kurihara H, Nakajima S, Kato T, Matsuzaka S. Chemonucleolytic effects of on normal rabbit intervertebral discs. Course of action up to 10 days post injection and minimum effective dose. Spine (Phila Pa 1976). 1996;21(21):2405–11.

    Article  CAS  Google Scholar 

  47. Riquelme C, Musacchio M, Mont’Alverne F, Tournade A. Chemonucleolysis of lumbar disc herniation with ethanol. J Neuroradiol. 2001;28:219–29.

    PubMed  CAS  Google Scholar 

  48. Theron J, Walker J, Cloete T. Percutaneous treatment of cervical disk hernias using gelified ethanol. AJNR Am J Neuroradiol. 2010;31(8):1454–6.

    Article  PubMed  CAS  Google Scholar 

  49. Couto JM, Castilho EA, Menezes PR. Chemonucleolysis in lumbar disc herniation: a meta-analysis. Clinics (Sao Paulo). 2007;62(2):175–80.

    Article  Google Scholar 

  50. Gibson JN, Grant IC, Waddell G. Surgical interventions for lumbar disc prolapse. Spine (Phila Pa 1976). 1999;24(17):1820–32.

    Article  CAS  Google Scholar 

  51. Javid MJ. Postchemonucleolysis discectomy versus repeat discectomy: a prospective 1- to 13-year comparison. J Neurosurg. 1996;85(2):231–8.

    Article  PubMed  CAS  Google Scholar 

  52. Javid MF, Norby EJ. Lumbar chymopapain nucleolysis. Neurosurg Clin N Am. 1996;7(1):17–27.

    PubMed  CAS  Google Scholar 

  53. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976). 2009;34(10):1078–93.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuroradiology The John Radcliffe Hospital, University of Oxford, Headley Way, OX3 9DU, Oxford, UK

    Dr. James Vincent Byrne

Authors
  1. Dr. James Vincent Byrne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James Vincent Byrne .

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Byrne, J.V. (2012). Embolisation, Vertebroplasty and Chemonucleolysis of Spinal Lesions. In: Tutorials in Endovascular Neurosurgery and Interventional Neuroradiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-19154-1_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-19154-1_20

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-19153-4

  • Online ISBN: 978-3-642-19154-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation