Combining Percutaneous Pedicular and Extrapedicular Access for Tumor Ablation in a Thoracic Vertebral Body

Abstract

We present a percutaneous modified technique to access large thoracic vertebral body lytic lesions, to increase the volume of tumor accessible to ablation, prior to cement augmentation.

Tumor ablation and cavity creation-assisted percutaneous vertebroplasty was considered a palliative measure for structural stabilization in plasmocytoma involvement of the entire T8 vertebral body. Given the extent of osteolysis bilateral combined transpedicular and extrapedicular access to the vertebral body was undertaken to maximize the volume of cavity creation within the tumor.

The combined transpedicular and extrapedicular access was feasible, uncomplicated, and successful in reaching all the quadrants of the anterior two thirds of the vertebral body. Slow, fluoroscopically monitored injection of high-viscosity cement resulted in a successful, desired cement distribution into the anterior two thirds of the vertebral body, spanning superior to inferior endplates, providing structural stability, in the absence of venous or epidural leakage.

The technical modification described in this case yielded positive results while overcoming some of the limitations of the existing coblation device. This approach may offer an option for cement augmentation of extensive vertebral body lytic lesions, at increased risk for tumor displacement and extra-vertebral cement leakage.

Keywords

vertebroplasty coblation tumor ablation spine tumor plasmocytoma osteolytic lesion

Get full access to this article

View all access options for this article.

References

Chiras

Depriester

Weill

. Percutaneous vertebral surgery. Technics and Indications. J Neuroradiol. 1997; 24 (1): 45–59.

Krishnaney

Steinmetz

Benzel

. Biomechanics of metastatic spine cancer. Neurosurg Clin N Am. 2004; 15 (4): 375–380. doi: 10.1016/j.nec.2004.04.001.

Carrafiello

Laganà

Ianniello

. Plasma-mediated radiofrequency ablation followed by percutaneous cementoplasty under fluro-CT guidance: a case report. Cases J. 2009; 2 (1): 8548. doi: 10.4076/1757-1626-2-8548.

Georgy

Wong

. Plasma-mediated radiofrequency ablation assisted percutaneous cement injection for treating advanced malignant vertebral compression fractures. Am J Neuroradiol. 2007; 28 (4): 700–705.

Schaefer

Lohrmann

Markmiller

. Technical innovation. Combined radiofrequency thermal ablation and percutaneous cementoplasty treatment of a pathologic fracture. J Vasc Interv Radiol. 2002;13 (10): 1047–1450. doi: 10.1016/S1051-0443(07)61872-7.

Georgy

. Bone cement deposition patterns with plasma-mediated radio-frequency ablation and cement augmentation for advanced metastatic spine lesions. Am J Neuroradiol. 2009; 30 (6): 1197–1202. doi: 10.3174/ajnr.A1548.

Hong

Georgiades

. Radiofrequency ablation: mechanism of action and devices. J Vasc Interv Radiol. 2010; 21(Suppl. 8): S179–186. doi: 10.1016/j.jvir.2010.04.008.

Klimo

Jr Schmidt

. Surgical management of spinal metastases. Oncologist. 2004; 9 (2): 188–196. doi: 10.1634/theoncologist.9-2-188.

Harrington

. The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease. J Bone Joint Surg Am. 1981; 63 (1): 36–46.