Intra-arterial Onyx Embolization of Vertebral Body Lesions
A 52-year-old male patient presented with six months of progressive bilateral lower extremity weakness and worsening sensory function, leading to multiple falls. There were also spasms and spasticity of the lower extremities bilaterally, and several episodes of fecal and urinary incontinence. A CT and total spine MRI revealed multiple lesions with coarse trabeculae in the thoracic (T1, T3 and T11) and lumbar spine (L1), most severe within the T3 vertebral body. These lesions extended to the posterior elements and soft tissues in the surrounding paravertebral and epidural space, causing significant anterior cord compression ().\nAn open biopsy confirmed an intraosseous hemangioma, and the patient was referred for embolization prior to anticipated surgical resection. The patient was placed under general anesthesia and standard access with a 5 French sheath in the common femoral artery was achieved. The right T4 segmental artery was selectively catheterized with a Cobra catheter (Terumo, Somerset, NJ, USA). Angiography demonstrated a large pathologic blush in the region of the T3 vertebral body, corresponding to the known hemangioma (). Opacification of a spinal pial artery was not seen. An Echelon microcatheter was advanced into the segmental artery and the vascular supply to the hemangioma was embolized with a total of 0.24 mL of Onyx-18 (). The procedural total fluoroscopy time was 27 minutes, and procedural duration was 2.5 hours. Post-embolization angiography via the Cobra catheter confirmed no further pathologic blush (, ). The patient recovered uneventfully from the embolization and surgical resection, the latter with 300 cc of estimated blood loss.