The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine.
A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.
Ahn
Henry
H
St. Michael's Hospital, Orthopaedic Surgery, University of Toronto, St. Michael's Orthopaedic Associates, 55 Queen St. East, Suite 800, Toronto, ON, Canada M5C IR6. ahnh@smh.toronto.on.ca
Mousavi
Payam
P
Chin
Lee
L
Roth
Sandra
S
Finkelstein
Joel
J
Vitken
Alex
A
Whyne
Cari
C
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D053685:Laser Therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D019637:Orthopedic Procedures / Q000379:methods*; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013125:Spinal Neoplasms / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000601:surgery*
D001843:Bone Cements; D019904:Polymethyl Methacrylate