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AJNR - American Journal of Neuroradiology

Published ahead of print on June 19, 2008
doi: 10.3174/ajnr.A1137

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Metastatic Spinal Lesions: State-of-the-Art Treatment Options and Future Trends

B.A. Georgy^a

^a From Valley Radiology Consultants, Escondido, Calif

View larger version (44K): [in this window] [in a new window]   Fig 1. The vertebral body can be depicted as a cube composed of 27 smaller cubes to indicate tumor location: oblique (A) and lateral (B) views. (Reprinted with permission from Elsevier Ltd.)

View larger version (39K): [in this window] [in a new window]   Fig 2. Tumor infiltration or damage to portions of the cube depicted in Fig 1 may destabilize the spine in varying fashions. Destruction of the middle third in the axial plane (A) results in gross instability, whereas destruction of the middle third in the sagittal plane (B) may not be associated with significant destabilization. A lesion in the ventral portion of the vertebral body in the coronal plane (C) affects stability more than a lesion in the middle (D) or dorsal (E and F) portions. (Reprinted with permission from Elsevier Ltd.)

View larger version (26K): [in this window] [in a new window]   Fig 3. The vertebral body and adjacent structures can be depicted as 4 disparate zones when considering surgery to treat vertebral body tumors.

View larger version (118K): [in this window] [in a new window]   Fig 4. A, A 71-year-old woman with undifferentiated cancer and a lesion at L4. B and C, A void is created in the vertebral body by debulking the spinal tumor using the plasma radio-frequency–based wand before vertebral body augmentation with bone cement. D–F, Axial (D and E) and sagittal (F) views by using MR imaging show excellent anterior placement of bone cement.

View larger version (24K): [in this window] [in a new window]   Fig 5. Candidates for percutaneous vertebral body augmentation who have spinal metastasis are best identified by evaluating the suggested treatment site by using CT and MR imaging (MRI). RFA indicates radio-frequency ablation.