Devoted to diagnostic and interventional spine imaging and therapeutics

Library

Combined Coblation Technology and Percutaneous Cement Injection in Treatment of Malignant Vertebral Lesions 2004

Georgy, Bassem, M.D.
James, Brandy, MA

Purpose:
To investigate the role of using coblation technology (Low-energy radiofrequency wave that removes tissue from the treatment area via a molecular dissociation process that converts the tissue into gases which exit the treatment site) to create a tissue void cavity before performing Vertebroplasty in treatment of vertebral malignant compression fractures.

Material and Methods:
Six vertebral bodies in 6 patients (4 males and 2 females) with mean age of 56 years and different metastatic lesions were included in the study after obtaining the appropriate consents. Cases included lesions with destruction of the posterior vertebral wall (two cases) vertebral and paraspinal exten sion (2 cases) and epidural tumor extension (two cases). 11G needles were used first to access the malignant lesions using a transpedicular approach under fluoroscopy guidance. A special coblation device (Arthrocare Sunnyvale, CA) was introduced through the needle and tissue coblation was performed to create a cavity by tissue destruction. The needle was then repositioned and bone cement was injected under fluoroscopy.

Results:
Adequate amount of cement was injected in every case. Post procedure imaging showed no evidence of extravasation of cement outside the presumed vertebral boundaries. All patients experienced marked pain relief. Coblation does not rely on heat energy to remove tissue, so thermal damage and tissue necrosis was avoided.

Conclusion:
The concept of creating a cavity by tissue destruction before injecting bone cement into a malignant vertebral lesion may help to reduce complication rate, in particular extravasation of cement into the spinal canal. Fur ther experience is needed to confirm this finding.