Delayed vertebral body collapse after stereotactic radiosurgery and radiofrequency ablation: Case report with histopathologic-MRI correlation

Adam N Wallace; Ross Vyhmeister; Andy C Hsi; Clifford G Robinson; Randy O Chang; Jack W Jennings

doi:10.1177/1591019915609131

Delayed vertebral body collapse after stereotactic radiosurgery and radiofrequency ablation: Case report with histopathologic-MRI correlation

Interv Neuroradiol. 2015 Dec;21(6):742-9. doi: 10.1177/1591019915609131. Epub 2015 Oct 23.

Authors

Adam N Wallace¹, Ross Vyhmeister², Andy C Hsi³, Clifford G Robinson⁴, Randy O Chang², Jack W Jennings⁵

Affiliations

¹ Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA [email protected].
² Washington University School of Medicine, Saint Louis, MO, USA.
³ Department of Pathology and Immunology, Division of Anatomic Pathology, Washington University School of Medicine, Saint Louis, MO, USA.
⁴ Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
⁵ Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.

Abstract

Stereotactic radiosurgery and percutaneous radiofrequency ablation are emerging therapies for pain palliation and local control of spinal metastases. However, the post-treatment imaging findings are not well characterized and the risk of long-term complications is unknown. We present the case of a 46-year-old woman with delayed vertebral body collapse after stereotactic radiosurgery and radiofrequency ablation of a painful lumbar metastasis. Histopathologic-MRI correlation confirmed osteonecrosis as the underlying etiology and demonstrated that treatment-induced vascular fibrosis and tumor progression can have identical imaging appearances.

Keywords: Metastatic spine disease; radiofrequency ablation; spinal stereotactic radiosurgery; vertebral augmentation; vertebral compression fracture.

Publication types

Case Reports

MeSH terms

Catheter Ablation*
Fatal Outcome
Female
Fluorodeoxyglucose F18
Fractures, Compression / diagnostic imaging
Fractures, Compression / etiology*
Fractures, Compression / surgery
Humans
Image-Guided Biopsy
Leiomyosarcoma / diagnostic imaging
Leiomyosarcoma / secondary
Leiomyosarcoma / surgery*
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / surgery
Magnetic Resonance Imaging
Middle Aged
Pain Measurement
Positron Emission Tomography Computed Tomography
Postoperative Complications / diagnostic imaging
Postoperative Complications / etiology*
Postoperative Complications / surgery
Radiopharmaceuticals
Radiosurgery*
Spinal Fractures / diagnostic imaging
Spinal Fractures / etiology*
Spinal Fractures / surgery
Spinal Neoplasms / diagnostic imaging
Spinal Neoplasms / secondary
Spinal Neoplasms / surgery*

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18