Percutaneous transforaminal endoscopic decompression combined with percutaneous vertebroplasty in treatment of lumbar vertebral body metastases: A case report

Abstract

Background: Percutaneous endoscopic lumbar discectomy (PTED) is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis. Despite its less invasiveness, this surgery is rarely used to treat spinal metastases. Percutaneous vertebroplasty (PVP) has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.

Case summary: A 68-year-old woman presented with low back pain and radicular symptoms. She couldn't straighten her legs because of severe pain. Computed tomography (CT) showed a mass lesion in the lung and bone destruction in the L4 vertebrae. The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma. PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time. Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation. The incision was scaled up with the TESSY technology. The pain was obviously relieved following the operation and no serious complications occurred. Postoperative CT showed that the decompression around the nerve root was successful, polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed. During the 1-year follow-up period, the patient was in a stable condition.

Conclusion: PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms. Because of the small sample size and short follow-up time, the long-term clinical efficacy of this method needs to be further confirmed.

Keywords: Case report; Minimally invasive surgery; Nerve root; Percutaneous; Spinal metastases; Transforaminal endoscopic decompression.

Figure 1

Computed tomography and magnetic resonance imaging. A: Sagittal position lumbar magnetic resonance imaging (MRI) showed a huge metastatic mass destroying L4 vertebral body and pedicle and compressing the nerve root; B: Cross-sectional lumbar MRI showed vertebral body and pedicle were damaged; C: L4 vertebral body and pedicle pathological fractured; D: L4 vertebral body and pedicle were damaged.

Figure 2

Histopathological examination. A: Hematoxylin-eosin stained L4 vertebral body biopsy (200 × magnification) showed metastatic adenocarcinoma; B: Hematoxylin-eosin stained L4 vertebral body biopsy (200 × magnification) showed metastatic adenocarcinoma; C: Hematoxylin-eosin stained L4 vertebral body biopsy (400 × magnification) showed metastatic adenocarcinoma.

Figure 3

Intraoperative imaging. A: Preoperative angiography showed that L4 vertebral bodies were abundant and selective arterial embolization was performed; B: The image illustrated sufficient decompression of intervertebral foramen, partial resection of vertebral body and pedicle of vertebral arch, and exposure of polymethyl methacrylate injected into vertebral body.

Figure 4

Postoperative computed tomography. A: Lumbar computed tomography showed that the decompression around the nerve root was successful, the percutaneous vertebroplasty filling was satisfactory; B: The tumor tissue around the nerve root was obviously removed.