Bone cement deposition patterns with plasma-mediated radio-frequency ablation and cement augmentation for advanced metastatic spine lesions.
OBJECTIVE
Combining percutaneous plasma-mediated radio-frequency (pmRF) ablation with vertebral body augmentation offers an alternative treatment to surgical intervention options for advanced metastatic spinal lesions and is particularly useful for cases with cortical destruction and/or epidural extension. This study evaluates bone cement deposition patterns and extravasation in treated vertebral bodies in relation to the metastatic lesion after using this combined approach.


METHODS
Retrospective assessments of CT images performed before/after the procedures were evaluated in 37 patients (44 levels) with advanced metastatic lesions. A void was created in the anterior portion of the tumor-infiltrated vertebral body by using a bipolar plasma-mediated radio-frequency-based wand, followed by deposition of bone cement. Pain measured by visual analog scale score was recorded preprocedure and 2-4 weeks afterward.


RESULTS
In 19 (43%) levels, 90%-100% of the cement was deposited in the anterior two thirds of the vertebral body. In 34 levels (77%), 75% or more of the cement was deposited in the anterior two thirds of the vertebral body. In 13/15 (86%) levels with posterior lesions, cement was deposited anterior to the lesion. No extravasation was observed in 13 levels (29.5%). Two clinically insignificant incidences of epidural extravasation were noted. Pain relief after the procedure was reported by 25/28 (89.5%) patients with available data.


CONCLUSIONS
pmRF ablation may allow greater cement-deposition control, increasing the likelihood of successfully stabilizing the anterior two thirds of the vertebral body. This combined technique appeared particularly useful in cases with posteriorly located lesions. The incidence of cement extravasation was relatively high but clinically insignificant.
Department of Radiology, University of California San Diego, San Diego, CA 92130, USA. bgeorgy@earthlink.net
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Georgy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000737:chemistry* / Q000627:therapeutic use*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000628:therapy*; D013131:Spine / Q000737:chemistry* / Q000601:surgery; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements