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Radiofrequency Ablation of Posterior Vertebral Body Metastatic Lesions Using an Articulating, Navigational Device 2014

Category Interventional Jack Jennings
Jeremiah Long
Purpose Demonstrate technical feasibility, safety, and initial clinical experience of targeted radiofrequency ablation (t-RFA) of posterior vertebral body lesions using a bipolar RF ablation system via a trans-pedicular approach. Report the use of temperature monitoring of thermocouples (TC) on the articulating electrode to determine ablation size and morphology with use of post-ablation imaging. Materials & Methods 67 posterior vertebral body lesions were treated with the STAR Tumor Ablation System which includes an articulating, navigational bipolar electrode containing two active TCs positioned to permit real time monitoring of the peripheral edge of the ablation zone to determine size of ablation. All vertebral bodies were accessed via a trans-pedicular approach. Pre- and post-procedural pain evaluation was performed. Cement augmentation via the same introducer cannula was performed when there was or risk of pathologic fracture or instability. Post-procedural contrast- enhanced MRI and/or PET/CT were performed in many cases to evaluate the ablation zone and tumor control. Results Lesions involved the thoracic and lumbar levels. All lesions were technically accessed and ablated with no complications or permanent neural thermal injury. There were 4 cases of post-ablation radicular pain that resolved with selective nerve root blocks. The intraprocedural imaging demonstrated that the articulating bipolar electrode could be navigated into the posterior vertebral body lesions via a trans-pedicular approach. Post-ablation contrast-enhanced MRIs and/or PET/CTs demonstrated discrete ablation zones with necrosis and in many cases tumor control with halting of posterior tumor growth within the canal. The majority of patients experienced pain relief. Conclusion Targeted radiofrequency ablation was both safe and feasible in treating painful posterior vertebral body metastatic lesions. The device provided easy access to posterior vertebral body lesions via a trans-pedicular approach, previously difficult to access with other conventional ablation devices. Real time monitoring of the peripheral edge of the ablation zone, with the use of the two built-in TCs, allowed for safe and controlled ablation of the posterior vertebral body lesions without permanent thermal nerve injury. Post ablation imaging demonstrated reproducible ablation zones and in many cases showed no further growth or canal extension of tumors previously nonresponsive to systemic or radiation therapy. References None