J Cerebrovasc Endovasc Neurosurg.  2013 Dec;15(4):320-325. 10.7461/jcen.2013.15.4.320.

Intra-arterial Onyx Embolization of Vertebral Body Lesions

• Sedora-Roman NI
• Gross BA
• Reddy AS
• Ogilvy CS
• Thomas AJ

• KMID: 1810792
• DOI: http://doi.org/10.7461/jcen.2013.15.4.320

Abstract

While Onyx embolization of cerebrospinal arteriovenous shunts is well-established, clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically, a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.

Keyword

Vertebral; Onyx; Endovascular; Embolization; Hemangioma

MeSH Terms

Carcinoma, Renal Cell
Hemangioma

Figure

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  Fig. 1 Axial noncontrast lumbar spine computed tomography (A) and sagittal reformat (B) show a destructive L2 lesion with extension into the left pedicle and large epidural soft tissue component causing moderate spinal canal stenosis. There is pathologic compression with at least 50% loss of height centrally. Axial (C) and sagittal (D) T2 magnetic resonance images demonstrate a large destructive L2 lesion with pathologic fracture and 4 mm soft tissue extension into the ventral spinal canal, resulting in moderate left sided spinal canal narrowing.

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  Fig. 2 Selective angiography of the left L2 segmental artery demonstrates a significant pathologic vascular blush at the level of the L2 vertebral body (A). Post-embolization unsubtracted radiograph shows Onyx distributed diffusely through the lateral vertebral body (B). Post-embolization selective left L2 segmental artery injection demonstrates grossly total angiographic devascularization of the L2 vertebral body tumor (C).

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  Fig. 3 Postembolization frontal (A) and lateral (B) lumbar spine radiographs show penetration of Onyx through tumor vessels within the L2 vertebral body. Reflux into the epidural venous plexus is seen.

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  Fig. 4 Axial computed tomography demonstrates a hypodense lesion with coarse trabeculae within the T3 vertebral body with extensive soft tissue in the surrounding paravertebral and epidural space causing significant anterior cord compression (A). Sagittal T2-weighted (B) and Short T1 Inversion Recovery (STIR) (C) magnetic resonance images of thoracic spine demonstrate a heterogeneous lesion at the T3 vertebral body extending laterally and posteriorly through the vertebral body and causing severe central canal compression.

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  Fig. 5 Selective angiography of the right T4 segmental artery demonstrates a pathologic blush in the region of the T3 vertebral body (A). Intraprocedural unsubtracted antero-posterior radiograph demonstrates Onyx distributed through the known T3 hemangioma (B). Post-embolization selective injection of the right T4 segmental artery demonstrates no residual opacification of the pathologic vascular blush (C).

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  Fig. 6 Postembolization axial noncontrast computed tomography (A) and coronal reformat (B) show penetration of Onyx through tumor vessels within the T3 vertebral body.

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