INTERVENTIONAL NEURORADIOLOGY  

                                     

   

24/7  Contact  &  Appointment  (310)  267-­‐8761  or  8762  

Pathological compression fracture of thoracic spine with partial loss of posterior wall

DIVISION  OF  INTERVENTIONAL  NEURORADIOLOGY  

Presents  a  patient  case  treated  by  the  team  members  of  the  division  

and  physicians  and  staff  of  the  UCLA  Comprehensive  Stroke  Center    

GARY  DUCKWILER,  MD  Director  and  Professor  

 FERNANDO  VINUELA,  MD  

Professor  Emeritus    

REZA  JAHAN,  MD  Professor  

 SATOSHI  TATESHIMA,  MD,  DMSc  

Associate  Professor    

NESTOR  GONZALEZ,  MD  Associate  Professor  

 VIKTOR  SZEDER,  MD,  PhD  

Assistant  Professor  

 

PATIENT  PRESENTATION  

Figure  1:  Severe  wedge  shaped  compression  fracture  of  T12  (white  arrow)  

• Late  30s  female  with  history  of  breast  cancer  developed  bone  metastases  including  T12  (Fig.1).    

• The  T12  lytic  bone  metastasis  caused  compression  fracture  with  25%  loss  of  height  

• She  suffered  from  uncontrollable  pain  from  the  fracture.    

EVALUATION  AND  IMAGING  

• Clear  percussion  tenderness  over  T12  spinous  process.  

• Based  on  imaging  and  clinical  symptoms,  her  Spine  Instability  Neoplasic  Score  was  nine  (0  -­‐18).  

INTERVENTION  PERFORMED  

• Vertebral  augmentation  procedure  (kyphoplasty)  was  performed  via  bi-­‐pedicular  access  (Fig.2).  

• Because  of  the  lytic  lesion,  very  thick  cement  (Xpede  cement,  Kyphone)  was  utilized.    

Figure  2:  Trans-­‐pedicular  access  to  T12  vertebral  body  and  drilling  the  lesion.  The  entire  procedure  was  done  under  conscious  sedation  and  local  anesthesia.  No  general  anesthesia  is  necessary.    

(over)  

ICA  

 INTERVENTIONAL NEURORADIOLOGY  

     

         

24/7  Contact  &  Appointment  (310)  267-­‐8761  or  8762  

                 

Procedures  provided  by  DINR  for  adult  and  pediatric  patients  

 Acute  Ischemic  Stroke    

Acute  Thrombectomy/Thrombolysis  Extra/Intracranial  Angioplasty/Stenting  

 Brain  Hemorrhage,  Aneurysm/AVM/fistulae  

Aneurysm  coiling  Stent/balloon  assisted  aneurysm  coiling  Flow  diverter  stent  device  embolization  

AVM/Dural  fistulae  embolization  Venous  Sinus  Thrombectomy/Thrombolysis    

Direct  transcutaneous  embolization    

Chronic  Occlusive  Cerebrovascular  Disease  Extra/Intracranial  Angioplasty/Stenting  

Venous  Sinus  Angioplasty/Stenting    

Head/neck/orbit  tumors  &  vascular  malformations,  epistaxis  

Endovascular  embolization  Direct  percutaneous  embolization  

Division  of  Interventional  Neuroradiology  David  Geffen  School  of  Medicine  at  UCLA  Ronald  Reagan  UCLA  Medical  Center  757  Westwood  Plaza,  Suite  2129  Los  Angeles,  CA  90095-­‐7437  http://radiology.ucla.edu/site.cfm?id=217  

KYPHOPLASTY  BALLONS  INFLATED  

Division  of  Interventional  Neuroradiology  –  A  Leader  in  Neurovascular  Care  and  Research    • Invented  the  Merci  retriever  –  the  1st  endovascular  device  for  acute  stroke  therapy    • Invented  GDC  and  Matrix  coils  –  the  leading  tool  for  aneurysm  treatment  around  the  world    • Developed  Onyx  liquid  embolic  material  –  the  leading  therapy  for  brain  vascular  malformations  

Figure  3:  Two  kyphoplasty  balloons  were  inserted  into  T12  vertebral  body.  Balloon  inflation  helps  not  just  with  regaining  the  height  but  also  reduces  chance  of  immature  cement  leakage  to  the  spinal  canal.    

Figure  4:  Kyphoplasty  balloons  were  carefully  inflated  in  T12  vertebral  body.  Also,  we  assured  the  patient  neurological  examination  did  not  change.    

THE  OUTCOME  

• The  patient  tolerated  the  procedure  well  without  any  complications.  Her  pain  diminished  dramatically  after  the  procedure.  

• Two  weeks  after  the  procedure,  the  patient  no  longer  had  the  pain  from  fracture.  

• In  carefully  selected  patients,  we  can  safely  treat  lytic  vertebral  compression  fractures.  

Figure  5:  T12  lytic  vertebral  body  metastasis  was  successfully  treated  with  Kyphoplast  with  use  of  Xpede  cement.  (the  dark  color  material  in  the  vertebral  body  is  the  cement)  

KYPHOPLASTY  BALLONS  PLACED