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Percutaneous Cryoablation and Vertebroplasty Therapy (CVT) in metastatic spinal involvement 2009

Interventional Spine

Francesco Massari, MD,
Giovanni Simonetti, MD, Non ASSR Member
Roberto Fiori, MD, Non ASSR Member
Dario A Bartolucci, MD, Non ASSR Member
Matteo Mammucari, MD, Non ASSR Member
Salvatore Masala, PhD, ASSR Member

Scientific Paper

Mentor Award: Yes

Institution where work was conducted

University of Rome “Tor Vergata”, Rome, Italy

Affiliation and Department

Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy

Address

81 Oxford Street
Italy
Rome, Alabama
133
Phone: +39 (339) 2488654
Email: massarimd@gmail.com

Purpose

The spinal column is the most common location among osseous sites for metastatic deposits. Typically thoracic spine is the most frequent site of disease (70%), followed by lumbar (20%) and cervical spine (10%).
Aim of this study is to determine the safety and effectiveness of Cryoablation and Vertebroplasty Therapy (CVT) in pain reduction and daily life activities improvement in patients with spinal painful metastatic lesions.

Methods & Materials

During a period between January 2006 and May 2008, we treated with CVT, 18 patients ( 11 men, 7 women; mean age 54 years) with at least three vertebral painful metastatic lesions, with positive Visual Analogue Scale (mean score: 8.1).
These terminally ill patients were neither candidate for resective surgery nor responding to conventional radiation treatment or chemotherapy.
Cryoablation was performed using two 17 Gauge cryoprobes, coaxially introduced through bone biopsy needles previously inserted into vertebral body. After Cryoablation, percutaneous injection of Polymethylmethacrylate (PMMA) was performed.

Results

Postprocedural evaluation confirmed reduction of the VAS (mean score: 3.8). There was a marked increased in activities of daily living and reduction in narcotics utilization. No serious complications were observed in our study.

Conclusion

In our experience CVT demonstrated to be an easy, effective and feasible technique. This minimally invasive procedure is ideal for treatment of patients with painful bone metastases. Where standard treatments have failed, combined Cryoablation and Vertebroplasty treatment is characterized by immediate pain relief, with only minor complications noted.

References

1. Rubinsky B (2000) Cryosurgery. Annu Rev Biomed Eng 2:157–187
2. Rubinsky B, Pegg DE (1988) A mathematical model for the freezing process in biological tissue. Proc R Soc Lond (Biol) 234:343–358
3. Harrington K (1993) Metastatic tumors of the spine: Diagnosis and treatment. J Am Acad Orthop Surg 1:76–86
4. Klimo P Jr, Schimdt MH (2004) Surgical management of spinal metastases. Oncologist 9:188–196
5. Gangi A, Sabharwal T, Irani FG, et al. (2006) Quality assurance guidelines for percutaneous vertebroplasty. Cardiovasc Intervent Radiol 29:173–178
6. Callstrom MR, Atwell TD, Charboneau JW, et al. (2006) Painful metastases involving bone: Percutaneous image-guided cryoablation: Prospective trial interim analysis. Radiology 241:572–580

Images

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