Needle-tract seeding after percutaneous vertebroplasty: a case report

Authors: Lee C, et al

STUDY DESIGN A case report.

OBJECTIVE We report a case of needle-tract seeding (NTS) of adenocarcinoma of the lung in the thoracic spine that manifested after vertebroplasty (VP).

SUMMARY OF BACKGROUND DATA NTS after a biopsy is sometimes observed. However, NTS after an injection, as in VP, is a very rare complication.

METHODS A 61-year-old female presented with a painful back mass and weakness in both lower extremities. She had been diagnosed with adenocarcinoma of the lung 2 years previously. The patient had complained of severe back pain 5 months before and was diagnosed with a metastatic pathological fracture of T4-T6. She underwent uneventful percutaneous VP at T4-T6 followed by radiation therapy at that time.

RESULTS Magnetic resonance imaging revealed that the subcutaneous mass extended to the right T5 pedicle with an extension to the adjacent epidural space of T4-T7. Paramedian skin incision was made like a spindle and the back mass was totally removed with the covering skin and surrounding soft tissue. The tumor was connected with lamina, but ribs and pleura were clear. We performed T4-T7 laminectomy, right T5 pediculectomy, epidural tumor curettage, pedicle screw placement at T2-T3, T6-T9. Histological analysis confirmed the diagnosis of metastatic adenocarcinoma of the lung. The patient recovered after the operation, and her back pain and weakness had improved.

CONCLUSION NTS can be caused by even VP in patients with a pathological fracture. NTS needs to be considered in cases where it is difficult to inject polymethyl methacrylate.