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Combined percutaneous cementation and plasma-mediated radiofrequency ablation in advanced metastatic lesions of the spine; Post procedure CT evaluation of cement deposition and leakage 2008

Interventional Spine

Bassem A Georgy, MD,

Scientific Paper

Purpose

Percutaneous Vertebroplasty or Kyphoplasty in conjunction with plasma-mediated radiofrequency ablation had been described in advanced metastatic disease of the spine (cases with cortical destruction, epidural extension or both). We retrospectively review axial CT examination of cases done using this technique to evaluate the pattern of cement deposition and incidence of leakages.

Methods & Materials

33 vertebral bodies in 30 patients with advanced metastatic lesions were included in the study after obtaining an appropriate institutional approval. A void was first created in the anterior part of the vertebral body using bipolar radiofrequency-based Wand (ArthroCare Co., Sunnyvale, CA) followed by a standard cementation. All patients underwent CT examination before and after the procedure. The cement distribution inside the vertebral bodies was evaluated in relation to location and leakage pattern. Pain relief was evaluated using visual analog scale before and within 2-4 weeks after the procedure during follow up.

Results

75% or more of the injected cement was deposited in the anterior 2/3 of the vertebral bodies in all the treated vertebrae except 6 levels. In 9 vertebral bodies, 100% of the cement was deposited in the anterior column. A total of 19 (57%) insignificant leakages (14 cortical and 5 venous) were noted. Twenty five patients reported pain relief.

Conclusion

Plasma-mediated radiofrequency ablation allows more control over cement deposition in the anterior column of the vertebral body. Such predictable pattern adds to the stability of the involved bone and can eventually replace extensive anterior surgical stabilization techniques. Although incidence of cement leakage using this technique appears to be relatively high, they are clinically insignificant and less than the published data based on CT evaluation in malignant lesions.

References

consultant, Medtronic, Kyphon Inc, Arthrocare, Advanced Bionics

1-Georgy BA, Wong W. Plasma-mediated radiofrequency ablation assisted percutaneous cement injection for treating advanced malignant vertebral compression fractures. AJNR Am J Neuroradiol. 2007 Apr;28(4):700-5.

2-Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, Chastanet P, Clarisse J. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up.
Radiology. 1996 Aug;200(2):525-30.