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. 2023 Jan;13(1):156-163.
doi: 10.1177/2192568221994800. Epub 2021 Feb 19.

Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs

Alvaro Silva González  1   2 , Rafael Llombart-Blanco  1 , Marcela Gallegos Angulo  3 , Carlos Villas Tomé  1 , Matías Alfonso Olmos-García  1
Affiliations

Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs

Alvaro Silva González et al. Global Spine J. 2023 Jan.

Abstract

Study design: Animal experimental model.

Objective: To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs.

Methods: We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed.

Results: The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis.

Conclusions: Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed.

Keywords: acrylic cement; cisplatin; leakage; methotrexate; vertebroplasty.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A. Example of epidural injection of PMMA. b. Example of prevertebral, perimuscular injection of PMMA. c and d. AP and lateral views showing epidural cement placement and prevertebral muscle cement location.
Figure 2.
Figure 2.
A. Release of the spinal cord after laminectomy. The arrow shows the PMMA in the epidural space near a pedicle. b. Spinal cord surrounded by dura mater marked with Chinese ink over the areas that contact the PMMA. c. Histological HE study of the spinal cord (thin arrow) and dura (wide arrow) that came into contact with the cement 4x magnification.
Figure 3.
Figure 3.
Hematoxylin and eosin microphotography of the spinal cord of a cisplatin group animal. a. 2x magnification, black arrows show lysis of cellular membranes, loss of normal spinal cord architecture, presence of spongious cells (liquefactive necrosis) and presence of hyaline microthrombi. b. 4x magnification, black arrows show spinal cord necrosis, yellow arrow shows normal spinal cord tissue. c. 20x magnification, arrows show spongious cells and membrane lysis. d. 40x magnification, the arrow shows hyaline microthrombi.
Figure 4.
Figure 4.
a. 20x magnification of HE microphotograph of paravertebral muscle of a cisplatin group animal. the arrows show wide areas of muscular necrosis.
See this image and copyright information in PMC

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References

    1. Wang F, Zhang H, Yang L, et al. Epidemiological characteristics of 1196 patients with spinal metastases: a retrospective study. Orthop Surg. 2019;11(6):1048–1053. - PMC - PubMed
    1. Bollen L, Dijkstra SPD, Bartels RHMA, et al. Clinical management of spinal metastases–the Dutch national guideline. Eur J Cancer. 2018;104:81–90. - PubMed
    1. Bartels RHMA, Feuth T, van der Maazen R, et al. Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis. Cancer. 2007;110(9):2042–2049. - PubMed
    1. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease. Spine (Phila Pa 1976). 2010;35(22):E1221–E1229. - PubMed
    1. Gong Y, Xu L, Zhuang H, et al. Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: a systematic review. Cancer Med. 2019;8(14):6176–6184. Blackwell Publishing Ltd. - PMC - PubMed

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