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A novel technique for treating advanced malignant vertebral compression fractures: Combined Percutaneous Radiofrequency Tissue Debulking and Bone Cement Injection 2006

Interventional Spine

Bassem A Georgy, MD, ASSR Member
Wade Wong, DO, FACR, Non ASSR Member

Scientific Paper

Purpose

Percutaneous cement injection procedures such as vertebroplasty or kyphoplasty are used successfully to treat patients with painful osteoporotic vertebral compression fractures (VCF). When these fractures occur because of a malignant lesion however, treatment can be challenging; often by the time symptoms occur, the tumor has extended into the epidural tissue and is associated with posterior cortical disruption. As a result, these patients have a higher likelihood of cement extravasation outside the vertebral body, which is thought to be associated with increased risk of complications. The purpose of this study was to investigate clinical viability and effectiveness of a technique designed to improve control of bone cement placement over conventional methods when treating patients with symptomatic VCF associated with malignancy.

Methods & Materials

All patients considered for this procedure had intractable pain determined to be associated with VCF resulting from metastasized malignancy (image 1). The procedure consisted of using a plasma-mediated radiofrequency-based device to remove tissue and etch a cavity within the affected vertebral body (images 2 & 3) and then filling the cavity and adjacent interstices (image 4) with bone cement to stabilize the vertebral body and relieve pain.

Results

Twenty-eight patients (36 vertebral bodies) with various types of metastatic lesions were treated. No evidence of cement extravasation outside the vertebral body boundary was detected in 34/36 (94%) cases, even in cases observed to have had severe posterior cortical compromise and prominent epidural involvement pre-operatively. Cement extravasation was clinically inconsequential in the two cases in which it was observed. All treated patients reported marked pain relief. No patients
were prevented from continuing other oncologic treatments.

Conclusion

Removing tissue to debulk a lesion and create a cavity before injecting bone cement into a vertebral body compromised by malignancy may reduce the complication rate observed when using a bone cement injection procedure. This technique may redirect the cement away from the spinal canal, particularly in cases with posterior cortical defect and epidural extension, while also conferring the additional benefits of improved interdigitation of cement and decreased risk of embolization. The resulting palliation potentially improves functionality and quality of life during and does not appear to affect the effectiveness of continued oncologic treatment.

References

Bassem Georgy MD. No financial interest. Member ArthroCare Speakers Bureau.

Wade Wong DO, FACR. No financial interest. Member ArthroCare Speakers Bureau.

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