{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:23:51Z","timestamp":1794324231486,"version":"4.9.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:p>Balloon kyphoplasty (BKP) has been proven to be safe and effective in the management of pathological vertebral compression fracture (VCF) due to metastatic spinal disease. The most common serious complications related to BKP include cement extravasation and new fractures at adjacent levels. Although the potential for \u201ctumor extravasation\u201d has been discussed as a potential iatrogenic complication, it has yet to be confirmed. The authors report on 2 cases of tumor extravasation following BKP, which they base on an observed unusual rapid tumor spread pattern into the adjacent tissues. They postulate that by increasing the vertebral body internal pressure and disrupting the tissues during balloon inflation and cement application, a soft-tissue tumor can be forced beyond the vertebral bony boundaries through pathological cortical defects. This phenomenon can manifest radiologically as subligamentous spread and\/or extension into venous sinusoids, resulting in epidural venous plexus involvement, with subsequent tumor migration into the adjacent vertebral segments. Accordingly, the authors advise caution in using BKP when significant epidural tumor is present. The complication they encountered has caused them to modify their preference such that they now first use radiosurgery and subsequently BKP to ensure the target is appropriately treated, and they are currently developing possible modifications of procedural technique to reduce the risk.<\/jats:p>","DOI":"10.3171\/2014.4.spine13695","type":"journal-article","created":{"date-parts":[[2014,6,6]],"date-time":"2014-06-06T10:06:22Z","timestamp":1402049182000},"page":"372-377","source":"Crossref","is-referenced-by-count":32,"title":["Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease"],"prefix":"10.3171","volume":"21","author":[{"given":"Juan Pablo","family":"Cruz","sequence":"first","affiliation":[{"name":"Department of Medical Imaging, Toronto Western Hospital, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Sahgal","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto;"},{"name":"Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cari","family":"Whyne","sequence":"additional","affiliation":[{"name":"Holland Musculoskeletal Research Program, Sunnybrook Research Institute, Department of Surgery, IBBME and IMS, University of Toronto; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Toronto Western Hospital, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine13695","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1007\/s00586-007-0375-1","article-title":"The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine","volume":"16","author":"Ahn","year":"2007"},{"key":"b2-spine13695","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1227\/NEU.0b013e318207780c","article-title":"Predictors of survival after surgical treatment of spinal metastasis","volume":"68","author":"Arrigo","year":"2011"},{"key":"b3-spine13695","series-title":"Lancet Oncol","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/S1470-2045(11)70008-0","article-title":"Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial","volume":"12","author":"Berenson","year":"2011"},{"key":"b4-spine13695","series-title":"J Clin Oncol","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1200\/JCO.2006.09.5281","article-title":"Palliative radiotherapy trials for bone metastases: a systematic review","volume":"25","author":"Chow","year":"2007"},{"key":"b5-spine13695","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"e343","DOI":"10.1016\/j.ijrobp.2012.04.034","article-title":"Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors","volume":"84","author":"Cunha","year":"2012"},{"key":"b6-spine13695","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.jocn.2009.04.007","article-title":"Clinical and radiographic results of balloon kyphoplasty for treatment of vertebral body metastases and multiple myelomas","volume":"17","author":"Dalbayrak","year":"2010"},{"key":"b7-spine13695","series-title":"J Clin Oncol","doi-asserted-by":"publisher","first-page":"3072","DOI":"10.1200\/JCO.2010.34.3897","article-title":"Spinal instability neoplastic score: an analysis of reliability and validity from the Spine Oncology Study Group","volume":"29","author":"Fourney","year":"2011"},{"issue":"1 Suppl","key":"b8-spine13695","series-title":"J Neurosurg","first-page":"21","article-title":"Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients","volume":"98","author":"Fourney","year":"2003"},{"key":"b9-spine13695","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"296","DOI":"10.3171\/spi.2005.3.4.0296","article-title":"Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures","volume":"3","author":"Gerszten","year":"2005"},{"issue":"6","key":"b10-spine13695","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.3171\/2009.9.FOCUS09184","article-title":"Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique","volume":"27","author":"Gerszten","year":"2009"},{"key":"b11-spine13695","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1016\/j.spinee.2010.09.020","article-title":"A pictorial classification atlas of cement extravasation with vertebral augmentation","volume":"10","author":"Lador","year":"2010"},{"key":"b12-spine13695","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1097\/BSD.0b013e3182337d69","article-title":"A cadaver study to compare vertebral augmentation with a high-viscosity cement to augmentation with conventional lower-viscosity cement","volume":"26","author":"Lador","year":"2013"},{"key":"b13-spine13695","series-title":"Skeletal Radiol","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s00256-010-1010-5","article-title":"Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients","volume":"40","author":"Lane","year":"2011"},{"key":"b14-spine13695","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1097\/BRS.0b013e3181a3c742","article-title":"Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications","volume":"34","author":"Lee","year":"2009"},{"key":"b15-spine13695","series-title":"Technol Cancer Res Treat","doi-asserted-by":"publisher","first-page":"15","DOI":"10.7785\/tcrt.2012.500230","article-title":"Minimal access spine surgery (MASS) for decompression and stabilization performed as an out-patient procedure for metastatic spinal tumours followed by spine stereotactic body radiotherapy (SBRT): first report of technique and preliminary outcomes","volume":"11","author":"Massicotte","year":"2012"},{"issue":"1 Suppl","key":"b16-spine13695","series-title":"J Neurosurg","first-page":"56","article-title":"Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae","volume":"99","author":"Mousavi","year":"2003"},{"key":"b17-spine13695","series-title":"Acta Radiol","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1080\/02841850601026427","article-title":"Balloon kyphoplasty for the treatment of pathological fractures in the thoracic and lumbar spine caused by metastasis: one-year follow-up","volume":"48","author":"Pflugmacher","year":"2007"},{"key":"b18-spine13695","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1007\/s00586-008-0701-2","article-title":"Balloon kyphoplasty in the treatment of metastatic disease of the spine: a 2-year prospective evaluation","volume":"17","author":"Pflugmacher","year":"2008"},{"key":"b19-spine13695","series-title":"J Clin Oncol","doi-asserted-by":"publisher","first-page":"5075","DOI":"10.1200\/JCO.2008.19.3508","article-title":"Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases","volume":"27","author":"Rose","year":"2009"},{"key":"b20-spine13695","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1002\/cncr.22991","article-title":"Pathologic fractures correlate with reduced survival in patients with malignant bone disease","volume":"110","author":"Saad","year":"2007"},{"key":"b21-spine13695","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"151","DOI":"10.3171\/2010.9.SPINE091005","article-title":"Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient. A review","volume":"14","author":"Sahgal","year":"2011"},{"key":"b22-spine13695","series-title":"Radiol Med (Torino)","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s11547-009-0431-5","article-title":"Combined radiofrequency and kyphoplasty in painful osteolytic metastases to vertebral bodies","volume":"115","author":"Sandri","year":"2010"},{"key":"b23-spine13695","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1097\/00007632-200102010-00016","article-title":"Surgical strategy for spinal metastases","volume":"26","author":"Tomita","year":"2001"},{"key":"b24-spine13695","series-title":"Breast Cancer Res Treat","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s10549-009-0712-7","article-title":"Beyond bisphosphonates: photodynamic therapy structurally augments metastatically involved vertebrae and destroys tumor tissue","volume":"124","author":"Won","year":"2010"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/21\/3\/article-p372.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/21\/3\/article-p372.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/21\/3\/article-p372.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T19:00:38Z","timestamp":1681585238000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/21\/3\/article-p372.xml"}},"subtitle":["Report of 2 cases"],"short-title":[],"issued":{"date-parts":[[2014,9]]},"references-count":24,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2014.4.spine13695","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2014,9]]}}}