PMC3658248_01
Preoperative imaging demonstrating osteolytic vertebral metastasis with complete involvement of the T10 vertebral body, extending to the cortical vertebral wall anteriorly and posteriorly.. Notes: T2-weighted short T1 inversion recovery magnetic resonance imaging (top row). Computed tomography (bottom row). Arrow shows the boundary of the bulging metastasis through the cortical wall.. Abbreviation: T1, time to inversion.
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Magnetic resonance imaging and spiral computed tomography (CT) with two-dimensional reconstruction revealed an osteolytic vertebral metastasis with complete involvement of the T10 vertebral body, extending to the cortical vertebral wall anteriorly and posteriorly (Figure 1).
Intraoperative images demonstrating: (A) access with 11-gauge needle; (B) introduction of the dilator; (C) placement of working cannula in lateral view with Kiva  Coil showing; (D) deployed Kiva implant in lateral view; (E) deployed Kiva implant in anteroposterior view; and (F) completed procedure with cement fill.
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T10 vertebral body (Figure 2A), a Kirschner guide-wire was inserted to allow the placement of a 6-gauge working cannula (Figure 2B). Through the 6-gauge introducer, the delivery system was inserted to allow the deployment of a nitinol coil-shaped guide-wire into the vertebral body (Figure 2C). The Kiva implant was then delivered over the nitinol guide-wire (Figure 2D) inside the osteolytic lesion of the vertebra (Figure 2E) to form a nesting, cylindrical column. After the coil was retracted, a total of 6 mL of radiopaque bone cement was gradually injected using a manual screw injector through the Kiva implant and its inner holes under fluoroscopic monitoring (Figure 2F).
Reformatted postoperative computed tomography scan demonstrating satisfactory bone cement distribution within the T10 vertebral body and the complete absence of extravasation either anteriorly or posteriorly.. Note: Arrows show coil implant boundaries.
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Post-procedural CT scan with multi-planar reformatting demonstrated a satisfactory bone cement distribution within the vertebral body and the complete absence of extravasation either anteriorly or posteriorly (Figure 3).