{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:03:00Z","timestamp":1780131780212,"version":"3.54.0"},"reference-count":114,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2009,12]]},"abstract":"\n Object<\/jats:title>\n Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and radiation therapy for the underlying malignant process. Spinal radiosurgery provides excellent long-term radiographic control for vertebral metastases. Percutaneous cement augmentation using polymethylmethacrylate (PMMA) may be contraindicated in lesions with spinal canal compromise due to the risk of displacement of tumor resulting in spinal cord or cauda equina injury. However, there is also significant morbidity associated with open corpectomy procedures in patients with metastatic cancer, especially in those who subsequently require adjuvant radiotherapy. This study evaluated a treatment paradigm for malignant vertebral compression fractures consisting of transpedicular coblation corpectomy combined with closed fracture reduction and fixation, followed by spinal radiosurgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Eleven patients (6 men and 5 women, mean age 58 years) with symptomatic vertebral body metastatic tumors associated with moderate spinal canal compromise were included in this study (8 thoracic levels, 3 lumbar levels). Primary histologies included 4 lung, 2 breast, 2 renal, and 1 each of thyroid, bladder, and hepatocellular carcinomas. All patients underwent percutaneous transpedicular coblation corpectomy immediately followed by balloon kyphoplasty through the same 8-gauge cannula under fluoroscopic guidance. Patients subsequently underwent radiosurgery to the affected vertebral body (mean time to treatment 14 days). Postoperatively, patients were assessed for pain reduction and neurological morbidity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were no complications associated with any part of the procedure. Adequate cement augmentation within the vertebral body was achieved in all cases. The mean radiosurgical tumor dose was 19 Gy covering the entire vertebral body. The procedure provided long-term pain improvement and radiographic tumor control in all patients (follow-up range 7\u201344 months). No patient later required open surgery. No radiation-induced toxicity or new neurological deficit occurred during the follow-up period.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This treatment paradigm for pathological fractures of percutaneous transpedicular corpectomy combined with cement augmentation followed by radiosurgery was found to be safe and clinically effective. This technique combines minimally invasive procedures that avoid the morbidity associated with open surgery while providing spinal canal decompression and immediate fracture stabilization, and then administering a single-fraction tumoricidal radiation dose.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2009.9.focus09184","type":"journal-article","created":{"date-parts":[[2009,12,1]],"date-time":"2009-12-01T10:04:21Z","timestamp":1259661861000},"page":"E9","source":"Crossref","is-referenced-by-count":64,"title":["Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique"],"prefix":"10.3171","volume":"27","author":[{"given":"Peter C.","family":"Gerszten","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward A.","family":"Monaco","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0270009","series-title":"Cancer J","first-page":"88","article-title":"Gamma knife radiosurgery in the treatment of patients with single and multiple brain metastases from carcinoma of the breast","volume":"6","author":"Amendola","year":"2000"},{"issue":"3 Suppl","key":"b2-0270009","series-title":"J Neurosurg","first-page":"413","article-title":"Safety and efficacy of stereotactic radiosurgery for tumors of the spine","volume":"101","author":"Benzil","year":"2004"},{"key":"b3-0270009","series-title":"J Neurosurg Spine","first-page":"256","article-title":"Operative management of metastatic and malignant primary subaxial cervical tumors","volume":"2","author":"Bilsky","year":"2005"},{"key":"b4-0270009","series-title":"Neurosurgery","first-page":"823","article-title":"Intensity-modulated stereotactic radiotherapy of paraspinal tumors: a preliminary report","volume":"54","author":"Bilsky","year":"2004"},{"key":"b5-0270009","series-title":"Neurosurg Clin N Am","first-page":"459","article-title":"Minimally invasive treatments for metastatic tumors of the spine","volume":"15","author":"Binning","year":"2004"},{"key":"b6-0270009","series-title":"Neurosurgery","first-page":"726","article-title":"Spinal metastasis: current status and recommended guidelines for management","volume":"5","author":"Black","year":"1979"},{"key":"b7-0270009","series-title":"J Neurosurg Spine","first-page":"336","article-title":"Percutaneous tumor curettage and interstitial delivery of samarium-153 coupled with kyphoplasty for treatment of vertebral metastases","volume":"10","author":"Cardoso","year":"2009"},{"key":"b8-0270009","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1288","article-title":"Phase I clinical evaluation of near-simultaneous computed tomographic image-guided stereotactic body radiotherapy for spinal metastases","volume":"59","author":"Chang","year":"2004"},{"key":"b9-0270009","series-title":"Oncology (Williston Park)","first-page":"209","article-title":"Current status and optimal use of radiosurgery","volume":"15","author":"Chang","year":"2001"},{"key":"b10-0270009","series-title":"J Neurosurg","first-page":"653","article-title":"Indications for nonoperative treatment of spinal cord compression due to breast cancer","volume":"47","author":"Cobb","year":"1977"},{"key":"b11-0270009","series-title":"Radiographics","first-page":"311","article-title":"Percutaneous vertebroplasty: state of the art","volume":"18","author":"Cotten","year":"1998"},{"key":"b12-0270009","series-title":"J Neurosurg Spine","first-page":"234","article-title":"Balloon kyphoplasty for vertebral compression fractures secondary to polyostotic fibrous dysplasia. Case report","volume":"3","author":"Deen","year":"2005"},{"issue":"3 Suppl","key":"b13-0270009","series-title":"J Neurosurg","first-page":"435","article-title":"Spinal lesions treated with Novalis shaped beam intensity modulated radiosurgery and stereotactic radiotherapy","volume":"101","author":"Desalles","year":"2004"},{"key":"b14-0270009","series-title":"Congress of Neurological Surgeons","article-title":"Cancellous bone ablation with a plasmamediated radiofrequency-based device: an in vivo study of temperature and gross effects in tissue","author":"Do","year":"2005"},{"key":"b15-0270009","series-title":"J Clin Oncol","first-page":"2382","article-title":"Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma","volume":"20","author":"Dudeney","year":"2002"},{"key":"b16-0270009","series-title":"Neurosurgery","first-page":"iii","article-title":"Foreward","volume":"51","author":"Fessler","year":"2002"},{"key":"b17-0270009","series-title":"J Neurosurg (1 Suppl)","first-page":"21","article-title":"Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients","volume":"98","author":"Fourney","year":"2003"},{"key":"b18-0270009","series-title":"Eur Spine Journal","first-page":"250","article-title":"Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures","volume":"14","author":"Gaitanis","year":"2005"},{"key":"b19-0270009","series-title":"American Society of Interventional Neuroradiology","article-title":"Combined coblation technology and percutaneous cement injection in treatment of malignant vertebral lesions","author":"Georgy","year":"2004"},{"key":"b20-0270009","series-title":"AJNR Am J Neuroradiol","first-page":"700","article-title":"Plasma-mediated radiofrequency ablation assisted percutaneous cement injection for treating advanced malignant vertebral compression fractures","volume":"28","author":"Georgy","year":"2007"},{"key":"b21-0270009","series-title":"J Neurosurg Spine","first-page":"288","article-title":"Stereotactic radiosurgery for spinal metastases from renal cell carcinoma","volume":"3","author":"Gerszten","year":"2005"},{"key":"b22-0270009","series-title":"J Neurosurg Spine","first-page":"296","article-title":"Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures","volume":"3","author":"Gerszten","year":"2005"},{"issue":"5","key":"b23-0270009","series-title":"Neurosurg Focus","first-page":"1","article-title":"CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine","volume":"14","author":"Gerszten","year":"2003"},{"key":"b24-0270009","series-title":"Neurosurgery","first-page":"89","article-title":"CyberKnife frameless stereotactic radiosurgery spinal lesions: clinical experience in 125 cases","volume":"55","author":"Gerszten","year":"2004"},{"key":"b25-0270009","series-title":"J Neurosurg Spine","first-page":"92","article-title":"Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures. 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studies","volume":"52","author":"Medin","year":"2002"},{"key":"b38-0270009","series-title":"Int J Radiat Oncol Biol Phys","first-page":"162","article-title":"Clinical results of retreatment of vertebral bone metastases by stereotactic conformal radiotherapy and intensity-modulated radiotherapy","volume":"55","author":"Milker-Zabel","year":"2003"},{"key":"b39-0270009","series-title":"J Neurosurg Spine","first-page":"564","article-title":"Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience","volume":"2","author":"North","year":"2005"},{"key":"b40-0270009","series-title":"The Lancet","first-page":"643","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial","volume":"366","author":"Patchell","year":"2005"},{"key":"b41-0270009","series-title":"Neurosurgery","first-page":"838","article-title":"Image-guided hypo-fractionated stereotactic radiosurgery 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Postoperative outcome and quality of life","volume":"24","author":"Weigel","year":"1999"},{"key":"b52-0270009","series-title":"Radiology","first-page":"241","article-title":"Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement","volume":"199","author":"Weill","year":"1996"},{"key":"b53-0270009","series-title":"Spine (Phila Pa 1976)","first-page":"1","article-title":"Spinal metastases: the obvious, the occult, and the impostors","volume":"15","author":"Wong","year":"1990"},{"key":"b54-0270009","series-title":"J Women's Imag","first-page":"117","article-title":"Vertebroplasty\/kyphoplasty","volume":"2","author":"Wong","year":"2000"},{"key":"b55-0270009","series-title":"Neurosurgery","first-page":"226","article-title":"A review of imageguided intensity-modulated radiotherapy for spinal tumors","volume":"61","author":"Yamada","year":"2007"},{"issue":"Suppl 3","key":"b56-0270009","series-title":"J Neurosurg","first-page":"419","article-title":"Image-guided procedures for intensity-modulated spinal radiosurgery. Technical note","volume":"101","author":"Yin","year":"2004"},{"key":"b57-0270009","series-title":"J Bone Joint Surg Am","first-page":"55","article-title":"Incidence of tumor metastasis to the lumbar spine; a comparative study of roentgenographic changes and gross lesions","volume":"35-A","author":"Young","year":"1953"},{"key":"b1-0270009","series-title":"Cancer J","first-page":"88","article-title":"Gamma knife radiosurgery in the treatment of patients with single and multiple brain metastases from carcinoma of the breast","volume":"6","author":"Amendola","year":"2000"},{"issue":"3 Suppl","key":"b2-0270009","series-title":"J Neurosurg","first-page":"413","article-title":"Safety and efficacy of stereotactic radiosurgery for tumors of the spine","volume":"101","author":"Benzil","year":"2004"},{"key":"b3-0270009","series-title":"J Neurosurg Spine","first-page":"256","article-title":"Operative management of metastatic and malignant primary subaxial cervical tumors","volume":"2","author":"Bilsky","year":"2005"},{"key":"b4-0270009","series-title":"Neurosurgery","first-page":"823","article-title":"Intensity-modulated stereotactic radiotherapy of paraspinal tumors: a preliminary report","volume":"54","author":"Bilsky","year":"2004"},{"key":"b5-0270009","series-title":"Neurosurg Clin N Am","first-page":"459","article-title":"Minimally invasive treatments for metastatic tumors of the spine","volume":"15","author":"Binning","year":"2004"},{"key":"b6-0270009","series-title":"Neurosurgery","first-page":"726","article-title":"Spinal metastasis: current status and recommended guidelines for management","volume":"5","author":"Black","year":"1979"},{"key":"b7-0270009","series-title":"J Neurosurg Spine","first-page":"336","article-title":"Percutaneous tumor curettage and interstitial delivery of samarium-153 coupled with kyphoplasty for treatment of vertebral metastases","volume":"10","author":"Cardoso","year":"2009"},{"key":"b8-0270009","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1288","article-title":"Phase I clinical evaluation of near-simultaneous computed tomographic image-guided stereotactic body radiotherapy for spinal metastases","volume":"59","author":"Chang","year":"2004"},{"key":"b9-0270009","series-title":"Oncology (Williston Park)","first-page":"209","article-title":"Current status and optimal use of radiosurgery","volume":"15","author":"Chang","year":"2001"},{"key":"b10-0270009","series-title":"J Neurosurg","first-page":"653","article-title":"Indications for nonoperative treatment of spinal cord compression due to breast cancer","volume":"47","author":"Cobb","year":"1977"},{"key":"b11-0270009","series-title":"Radiographics","first-page":"311","article-title":"Percutaneous vertebroplasty: state of the art","volume":"18","author":"Cotten","year":"1998"},{"key":"b12-0270009","series-title":"J Neurosurg Spine","first-page":"234","article-title":"Balloon kyphoplasty for vertebral compression fractures secondary to polyostotic fibrous dysplasia. Case report","volume":"3","author":"Deen","year":"2005"},{"issue":"3 Suppl","key":"b13-0270009","series-title":"J Neurosurg","first-page":"435","article-title":"Spinal lesions treated with Novalis shaped beam intensity modulated radiosurgery and stereotactic radiotherapy","volume":"101","author":"Desalles","year":"2004"},{"key":"b14-0270009","series-title":"Congress of Neurological Surgeons","article-title":"Cancellous bone ablation with a plasmamediated radiofrequency-based device: an in vivo study of temperature and gross effects in tissue","author":"Do","year":"2005"},{"key":"b15-0270009","series-title":"J Clin Oncol","first-page":"2382","article-title":"Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma","volume":"20","author":"Dudeney","year":"2002"},{"key":"b16-0270009","series-title":"Neurosurgery","first-page":"iii","article-title":"Foreward","volume":"51","author":"Fessler","year":"2002"},{"key":"b17-0270009","series-title":"J Neurosurg (1 Suppl)","first-page":"21","article-title":"Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients","volume":"98","author":"Fourney","year":"2003"},{"key":"b18-0270009","series-title":"Eur Spine Journal","first-page":"250","article-title":"Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures","volume":"14","author":"Gaitanis","year":"2005"},{"key":"b19-0270009","series-title":"American Society of Interventional Neuroradiology","article-title":"Combined coblation technology and percutaneous cement injection in treatment of malignant vertebral lesions","author":"Georgy","year":"2004"},{"key":"b20-0270009","series-title":"AJNR Am J Neuroradiol","first-page":"700","article-title":"Plasma-mediated radiofrequency ablation assisted percutaneous cement injection for treating advanced malignant vertebral compression fractures","volume":"28","author":"Georgy","year":"2007"},{"key":"b21-0270009","series-title":"J Neurosurg Spine","first-page":"288","article-title":"Stereotactic radiosurgery for spinal metastases from renal cell carcinoma","volume":"3","author":"Gerszten","year":"2005"},{"key":"b22-0270009","series-title":"J Neurosurg Spine","first-page":"296","article-title":"Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures","volume":"3","author":"Gerszten","year":"2005"},{"issue":"5","key":"b23-0270009","series-title":"Neurosurg Focus","first-page":"1","article-title":"CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine","volume":"14","author":"Gerszten","year":"2003"},{"key":"b24-0270009","series-title":"Neurosurgery","first-page":"89","article-title":"CyberKnife frameless stereotactic radiosurgery spinal lesions: clinical experience in 125 cases","volume":"55","author":"Gerszten","year":"2004"},{"key":"b25-0270009","series-title":"J Neurosurg Spine","first-page":"92","article-title":"Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures. 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studies","volume":"52","author":"Medin","year":"2002"},{"key":"b38-0270009","series-title":"Int J Radiat Oncol Biol Phys","first-page":"162","article-title":"Clinical results of retreatment of vertebral bone metastases by stereotactic conformal radiotherapy and intensity-modulated radiotherapy","volume":"55","author":"Milker-Zabel","year":"2003"},{"key":"b39-0270009","series-title":"J Neurosurg Spine","first-page":"564","article-title":"Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience","volume":"2","author":"North","year":"2005"},{"key":"b40-0270009","series-title":"The Lancet","first-page":"643","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial","volume":"366","author":"Patchell","year":"2005"},{"key":"b41-0270009","series-title":"Neurosurgery","first-page":"838","article-title":"Image-guided hypo-fractionated stereotactic radiosurgery 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stereotaxy","volume":"57","author":"Shiu","year":"2003"},{"key":"b46-0270009","series-title":"J Bone Joint Surg Br","first-page":"434","article-title":"Current concepts in the management of metastatic spinal disease. The role of minimally-invasive approaches","volume":"88","author":"Singh","year":"2006"},{"key":"b47-0270009","series-title":"Oncology (Williston Park)","first-page":"1419","article-title":"Stereotactic body radiation therapy. 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