Potential Complications of Percutaneous Vertebroplasty Combined with Interstitial Implantation of 125I Seeds for Metastatic Spinal Tumors: A Case Report and Literary Review

Abstract

Percutaneous vertebroplasty is often used to acquire the stability of the spine and relieve the pain caused by osteoporotic vertebral compressive fracture (OVCF). ¹²⁵I seeds have been used for application of local therapy for tumors. A combined treatment was reported in previous literatures. Thus, this case report is aimed at reporting a patient with an occurrence of delayed radioactive myelopathy, who accepted percutaneous vertebroplasty combined with interstitial implantation of ¹²⁵I seeds for metastatic spinal tumors, and at reviewing the published literatures.

Figure 1

The preoperative thoracic magnetic resonance imaging (MRI) showed a minor intraspinal occupying-lesion and associated pathological fractures of the vertebrae. (a, b) The T1-weighted and T2-weighted images show the fractures of the thoracic vertebrae body. (c) The cross section shows a possibility of an intraspinal space-occupying lesion in the T4 level like the black arrow indicated.

Figure 2

(a, b) The regular films of X-ray about the thoracic vertebrae show bone cement plus ¹²⁵I seeds in the T4 body. Black arrow indicates the location of ¹²⁵I seeds close to the back wall of the vertebra.

Figure 3

(a) The postoperative CT shows bone cements and metallic implants in T4 without any leakage in the T4 vertebrae body. (b) The postoperative MRI shows a larger intraspinal space-occupying lesion in the T4 intraspinal level. (c) The enhanced CT indicated the possibility of tissue tumor. The blue arrow and red arrow indicate the possibility of tissue tumor or hematoma.

Figure 4

(a, b) Photograph of the tissues of intraspinal space-occupying lesion and are H&E ×100 pictures. These show that the fiber tissues keep their normal shape without any discovery of tumor cells.

Figure 5

(a) T1-weighted image shows that the T4 body was filled with PMMA and ¹²⁵I seeds. (b–d) The high signal intensity of the spinal cord in T2-weighted and fat-suppression images in the T5 level. The white arrow shows the high signal intensity of the spinal cord.

Figure 6

The summarized indications of the PVP plus interstitial implantation of ¹²⁵I particles. The majority of indications of the PVP combined with interstitial implantation of ¹²⁵I particles include the definite radiographic and physical evidence, back pain as the major clinical symptom, and with more than three months of the estimated survival time. The second indications consist of normal function of main organs, with ability of prone position (more than 2 hours), and without spinal cord or nerve compression.