Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs
Journal
Global Spine Journal
ISSN
2192-5682
2192-5690
Date Issued
2021
Author(s)
Silva González, Alvaro
Rafael Llombart-Blanco
Gallegos Angulo, Marcela
Carlos Villas Tomé
Matías Alfonso Olmos-García
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Study Design:</jats:title><jats:p> Animal experimental model. </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed. </jats:p></jats:sec>
Subjects
acrylic cement
;
cisplatin
;
leakage
;
methotrexate
;
vertebroplasty
;
acrylic cement
;
ampicillin
;
atropine
;
azaperone
;
buprenorphine
;
chlorhexidine
;
cisplatin
;
etomidate
;
ketamine
;
methotrexate
;
pancuronium
;
poly(methyl methacrylate)
;
animal experiment
;
animal model
;
animal tissue
;
anorexia
;
article
;
autopsy
;
clinical outcome
;
diarrhea
;
dyspnea
;
euthanasia
;
fatigue
;
histology
;
inflammation
;
metaplasia
;
motor dysfunction
;
muscle necrosis
;
nonhuman
;
paraplegia
;
percutaneous vertebroplasty
;
petechia
;
pig
;
pneumonia
;
prophylaxis
;
spine metastasis