Epidural Balloon Placement for Protection of the Spinal Canal During Cryoablation of Paraspinal Lesions

Abstract

Ablation of paraspinal lesions close to the spinal canal and neuroforamina requires protective measures in order to protect the spinal cord and nerve roots. Various methods of protection have been previously described including infusion of saline and CO. Regardless, neuromonitoring should be adjunctively performed when ablating spinal lesions close to neuronal structures. Balloon protection has been previously described during ablation of renal masses. The benefit of balloon protection in paraspinal mass ablation is it physically displaces the nerve roots as opposed to CO or saline which has the potential to insulate but because of its aerosolized or fluid nature may or may not provide definitive continuous protection throughout an ablation. This report details three paraspinal lesions, two of which were successfully ablated with the use of a balloon placed in the epidural space to provide protection to the spinal cord and nerve roots.

Percutaneous Interventional Techniques for Treatment of Spinal Metastases

“…Epidural balloons may also be used for active neural thermal protection when ablating spinal lesions. 33 Passive thermal protection strategies include patient biofeedback when ablating under conscious sedation, real-time temperature monitoring by placement of thermocouples within the epidural space and/or neuroforamina, motor and somatosensory evoked potential amplitude monitoring, as well as electrostimulation of peripheral nerves for early detection of impending nerve injury. [6][7][8]12,13,26 Approaches to minimize skin thermal injury include precise assessment of ablation zone size and geometry, surface application of warm saline during cryoablation, using bipolar RF electrode systems, and utilization of wider and more grounding pads with unipolar RF systems.…”