{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:46:56Z","timestamp":1760240816266,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,9,24]],"date-time":"2019-09-24T00:00:00Z","timestamp":1569283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: We describe a novel technique for percutaneous tumor debulking and cavity creation in patients with extensive lytic lesions of the vertebral body including posterior wall dehiscence prior to vertebral augmentation (VA) procedures. The mechanical cavity is created with a combination of curettage and vacuum suction (Q-VAC). Balloon kyphoplasty and vertebral body stenting are used to treat neoplastic vertebral lesions and might reduce the rate of cement leakage, especially in presence of posterior wall dehiscence. However, these techniques could theoretically lead to increased intravertebral pressure during balloon inflation with possible mobilization of soft tissue tumor through the posterior wall, aggravation of spinal stenosis, and resultant complications. Creation of a void or cavity prior to balloon expansion and\/or cement injection would potentially reduce these risks. Materials and Methods: A curette is coaxially inserted in the vertebral body via transpedicular access trocars. The intravertebral neoplastic soft tissue is fragmented by multiple rotational and translational movements. Subsequently, vacuum aspiration is applied via one of two 10 G cannulas that had been introduced directly into the fragmented lesion, while saline is passively flushed via the contralateral cannula, with lavage of the fragmented solid and fluid-necrotic tumor parts. Results: We applied the Q-VAC technique to 35 cases of thoracic and lumbar extreme osteolysis with epidural mass before vertebral body stenting (VBS) cement augmentation. We observed extravertebral cement leakage on postoperative CT in 34% of cases, but with no clinical consequences. No patients experienced periprocedural respiratory problems or new or worsening neurological deficit. Conclusion: The Q-VAC technique, combining mechanical curettage and vacuum suction, is a safe, inexpensive, and reliable method for percutaneous intravertebral tumor debulking and cavitation prior to VA. We propose the Q-VAC technique for cases with extensive neoplastic osteolysis, especially if cortical boundaries of the posterior wall are dehiscent and an epidural soft tissue mass is present.<\/jats:p>","DOI":"10.3390\/medicina55100633","type":"journal-article","created":{"date-parts":[[2019,9,25]],"date-time":"2019-09-25T03:51:18Z","timestamp":1569383478000},"page":"633","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation"],"prefix":"10.3390","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5609-0998","authenticated-orcid":false,"given":"Eike I.","family":"Piechowiak","sequence":"first","affiliation":[{"name":"University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6831-344X","authenticated-orcid":false,"given":"Maurizio","family":"Isalberti","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Pileggi","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Distefano","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua A.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9333-4912","authenticated-orcid":false,"given":"Alessandro","family":"Cianfoni","sequence":"additional","affiliation":[{"name":"University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"},{"name":"Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1007\/s00586-003-0525-z","article-title":"Vertebroplasty in the treatment of vertebral tumors: Postprocedural outcome and quality of life","volume":"12","author":"Alvarez","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","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","journal-title":"Lancet Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"210","DOI":"10.3174\/ajnr.A4096","article-title":"Vertebral augmentation for neoplastic lesions with posterior wall erosion and epidural mass","volume":"36","author":"Cianfoni","year":"2015","journal-title":"Am. J. Neuroradiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s11604-010-0542-x","article-title":"Therapeutic effects of percutaneous vertebroplasty for vertebral metastases","volume":"29","author":"Mikami","year":"2011","journal-title":"Jpn. J. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s00256-018-3032-3","article-title":"Instability and impending instability in patients with vertebral metastatic disease","volume":"48","author":"Leone","year":"2019","journal-title":"Skelet. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1136\/jnis.2010.002675","article-title":"Palliation of compression fractures in cancer patients by vertebral augmentation: A retrospective analysis","volume":"2","author":"Jha","year":"2010","journal-title":"J. Neurointerv. Surg."},{"key":"ref_7","first-page":"45","article-title":"Percutaneous vertebral surgery. Technics and indications","volume":"24","author":"Chiras","year":"1997","journal-title":"J. Neuroradiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1002\/jso.23608","article-title":"Percutaneous vertebroplasty for painful spinal metastasis with epidural encroachment","volume":"110","author":"Sun","year":"2014","journal-title":"J. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s00270-008-9324-6","article-title":"Percutaneous vertebroplasty and bone cement leakage: Clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures","volume":"31","author":"Anselmetti","year":"2008","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/BSD.0b013e318213c113","article-title":"Comparison of kyphoplasty and vertebroplasty for treatment of painful osteoporotic vertebral compression fractures: Twelve-month follow-up in a prospective nonrandomized comparative study","volume":"25","author":"Li","year":"2012","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3171\/2018.6.SPINE18206","article-title":"Change in the cross-sectional area of the thecal sac following balloon kyphoplasty for pathological vertebral compression fractures prior to spine stereotactic radiosurgery","volume":"30","author":"Lis","year":"2018","journal-title":"J. Neurosurg. Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"372","DOI":"10.3171\/2014.4.SPINE13695","article-title":"Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease","volume":"21","author":"Cruz","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/BRS.0b013e31822e7a98","article-title":"Estimating risk of pulmonary neoplastic embolism during vertebroplasty","volume":"37","author":"Axelsen","year":"2012","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.jvir.2007.02.018","article-title":"Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: Preliminary results in 12 patients","volume":"18","author":"Kroft","year":"2007","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_15","first-page":"1502","article-title":"Cardiovascular changes during multiple vertebroplasty with and without vent-hole: An experimental study in sheep","volume":"28","author":"Aebli","year":"2003","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1080\/17453670510045570","article-title":"Polymethylmethacrylate causes prolonged pulmonary hypertension during fat embolism: A study in sheep","volume":"76","author":"Aebli","year":"2005","journal-title":"Acta Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1038\/s41408-019-0187-7","article-title":"The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: A consensus statement from the International Myeloma Working Group (IMWG)","volume":"9","author":"Kyriakou","year":"2019","journal-title":"Blood Cancer J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13018-015-0160-5","article-title":"The effect of void creation prior to vertebroplasty on intravertebral pressure and cement distribution in cadaveric spines with simulated metastases","volume":"10","author":"Li","year":"2015","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1097\/01.RVI.0000133507.40193.E4","article-title":"Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies","volume":"15","author":"Nakatsuka","year":"2004","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.2106\/JBJS.16.01182","article-title":"Cryoablation of Bone Metastases from Renal Cell Carcinoma for Local Tumor Control","volume":"99","author":"Gardner","year":"2017","journal-title":"J. Bone Jt. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"189","DOI":"10.3174\/ajnr.A4521","article-title":"Spine Cryoablation: Pain Palliation and Local Tumor Control for Vertebral Metastases","volume":"37","author":"Tomasian","year":"2016","journal-title":"Am. J. Neuroradiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"666","DOI":"10.3174\/ajnr.A3363","article-title":"A randomized trial comparing 2 techniques of balloon kyphoplasty and curette use for obtaining vertebral body height restoration and angular-deformity correction in vertebral compression fractures due to osteoporosis","volume":"34","author":"Bastian","year":"2013","journal-title":"Am. J. Neuroradiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1007\/s00586-018-5804-9","article-title":"Bone marrow washout for multilevel vertebroplasty in multiple myeloma spinal involvement. Technical note","volume":"28","author":"Hershkovich","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/neurintsurg-2018-014231","article-title":"Vertebral body stent augmentation to reconstruct the anterior column in neoplastic extreme osteolysis","volume":"11","author":"Cianfoni","year":"2019","journal-title":"J. Neurointerv. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1136\/neurintsurg-2018-014481","article-title":"Stent-screw-assisted internal fixation: The SAIF technique to augment severe osteoporotic and neoplastic vertebral body fractures","volume":"11","author":"Cianfoni","year":"2018","journal-title":"J. Neurointerv. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s11864-017-0516-7","article-title":"Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: An Update","volume":"18","author":"Kam","year":"2017","journal-title":"Curr. Treat. Opt. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Dabravolski, D., Esser, J., Lahm, A., and Merk, H. (2017). Surgical treatment of tumours and metastases of the spine by minimally invasive cavity-coblation method. J. Orthop. Surg., 25.","DOI":"10.1177\/2309499016684505"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1177\/1534734612466871","article-title":"Coblation technology for surgical wound debridement: Principle, experimental data, and technical data","volume":"11","author":"Trial","year":"2012","journal-title":"Int. J. Low. Extrem. Wounds"},{"key":"ref_29","first-page":"E906","article-title":"The effect of pulsed jet lavage in vertebroplasty on injection forces of polymethylmethacrylate bone cement, material distribution, and potential fat embolism: A cadaver study","volume":"33","author":"Benneker","year":"2008","journal-title":"Spine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1007\/s00586-010-1555-y","article-title":"Cardiovascular changes after PMMA vertebroplasty in sheep: The effect of bone marrow removal using pulsed jet-lavage","volume":"19","author":"Benneker","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1007\/s00586-009-1079-5","article-title":"The effect of pulsed jet lavage in vertebroplasty on injection forces of PMMA bone cement: An animal study","volume":"18","author":"Boger","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3463","DOI":"10.1007\/s00586-015-4191-8","article-title":"Lavage prior to vertebral augmentation reduces the risk for cement leakage","volume":"25","author":"Hoppe","year":"2016","journal-title":"Eur. Spine J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/10\/633\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:23:51Z","timestamp":1760189031000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/10\/633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,24]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,10]]}},"alternative-id":["medicina55100633"],"URL":"https:\/\/doi.org\/10.3390\/medicina55100633","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2019,9,24]]}}}