Abstract No. 35: Initial Clinical Experience with Radio-Frequency Based Vertebral Augmentation in Treatment of Vertebral Compression Fractures

et al. 2016

Z Orthop Unfall

Until recently, it was almost impossible to perform major surgery on metastases in the spine. This is especially the case for multiple spinal metastases and for older multi-morbid patients with higher OP risks. It is very important in such cases that the operation should be as minimally invasive as possible, and should aim to reduce pain, treat fractures and to improve the quality of life. The aim of this publication is to present and discuss the specific features of the methodology, problems, surgical techniques, as well as the effectiveness of the modernised cavity/coblation method and results of the treatment of 240 patients with spine metastases. Patients: Patients of every age with bone destruction were treated, with osteolysis and pathological fractures of vertebrae caused by metastases. The pre-operative diagnosis was evaluated by X-Ray, MRT, CT, whole-body F-FDG-PET, whole-body bone scintigraphy, histology. Cavity/coblation method: Tumour resection was carried out by the plasma field (42 °C, cold energy) over the percutaneous trans-/extrapedicular access and was followed by balloon kyphoplasty. Tumour tissue was removed, deformation corrected and stability enhanced. The treatment clearly reduced the risks of recurrence, fracture and compression of the neural structures. Local radiotherapy and chemotherapy were performed post-operatively. Clinical and radiological follow-ups, included tumour staging, were performed regularly after the OP (after 2 and 14 days and 3, 6,12, 24, 36, 48 and 60 months), including data on pain and improvement in quality of life. Within 6 years (03/08-04/14), we treated 240 patients with multiple spinal metastases (146 female, 94 male, age range 31-92 years, average age 65.5 years) or 784 vertebral bodies. 61 patients were also given dorsal percutaneous instrumentation and straightening. All patients experienced a significant reduction in pain, and improvements in satisfaction and quality of life. Treatment was combined with chemotherapy and local radiotherapy to reduce tumour cell growth or recurrence rate. Patients could be rapidly mobilised after surgery, blood loss was minimal, and the next oncology treatment could be initiated immediately. Cavity/coblation is a safe and minimally invasive procedure, as confirmed by our own short- and long-term results, as well as by reports/publications of other workers. OP risks, blood loss, and surgical time are lower and shorter. This new method is very promising for the future. It is important that the indication is correct and the treatment strategy must be adapted individually. Prognosis must be assessed and the surgical technique must be precise.

unclassified

Besonderheiten der Diagnostik und der minimalinvasiven chirurgischen Behandlung von multiplen Metastasen an der Wirbelsäule durch Plasmafeldtherapie (Cavity-Coblation-Methode)

Dabravolski¹,

Eßer

et al. 2016

Z Orthop Unfall

“…It was controlled two times respectively using 3D navigation to place the screws precisely, which is especially important in cases of metastasis in the neighbouring vertebral bodies. The results were controlled both clinically and radiologically 2, 14 days, 3,6,12,24,36,48 and 60 months after the operation. Postoperatively no sintering or FixtureLoosening/Dislocation appeared.…”

Section: Treated Patients and Metastases Speciesmentioning

confidence: 97%

“…[20] In balloon kyphoplasty [21][22][23] the balloons creates only a cave and the tumour cells are only pushed to the side, which increases the risk of tumour spread to blood vessels. Even in the radiofrequency kyphoplasty [24][25][26][27] is the tumor not removed and only deported by the bone cement to the side, where there is also the risk of tumor spread through the blood vessels. In both methods occurs no removal of the tumour tissue.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgical treatment of tumors and metastases of the spine by plasma field therapy (Cavity-Coblation method)

Dabravolski¹,

Eßer²,

et al. 2016

CSS

Background: Tumours and metastases of the spine are extremely stressful for patients. A radical surgery of metastases of the spine is not possible in many cases. Especially higher risk elder multimorbid patients are at risk. The therapeutic goals are always: small invasiveness, high efficiency of tumour removal, fracture repositioning, stabilisation, pain reduction, improving the patient's life quality. The specialness and difficulties of the diagnosis and therapy with the Cavity/Coblation-method the operative technique, results of the treatment of more than 274 patients with vertebral body tumours/metastases is going to be presented. Materials and methods: Patients: Patients of every age with destruction were treated: with osteolysis, Fractures of the spine caused by spinal tumours and metastases. Diagnosis preoperatively was evaluated through X-Ray, MRT, CT, complete body PET, histology. Cavity/Coblation method: The tumour tissue resection in the vertebra was carried out by the plasma field (T 42• C, cold energy) over the percutaneous transpedicular or extrapedicular access and was followed by vertebroplasty or balloon kyphoplasty with PMMA bone cement. This was followed up with clinical and radiological examinations, including data concerning pain and improvement of life quality after 2, 14 days as well as 3, 6, 12, 24, 36, 48 and 60 months postoperatively. Results: Within 6 years (03/08-04/14) more than 274 patients (171 female, 103 male, age range of 31-92 y. old average age of 65.7) or 895 vertebral bodies with tumours or metastases were treated. In 61 cases of 274, dorsal percutaneous instrumentation und straightening was an additional treatment. A small amount of blood loss and a very low complication rate was recorded. Postoperatively was shown by all patients an obvious reduction of pain, increase in life quality, satisfaction with the operative result, rapid mobilization was possible as well as the immediate radiation and chemotherapy for reduction of the local tumour recurrence rate. The complications were as follows: in 39 cases of 274 a cement leakage occurred laterally or in the intervertebral disc space without clinical relevance. 194 patients (105 women, 89 men) are now deceased due to tumour manifestations. Conclusions: Coblation/Cavity has shown itself to be a safe, minimal invasive procedure with good short and long term results, a low complication rate, blood loss and short surgery times. The total local recurrence rate for all patients with spine metastases in the study was in 35 from 250 cases/patients with metastasen or only in 14.0%. Following things are important: a comprehensive diagnostic including tumour staging, correct indication, prognostic assessment and precise surgical technique. The method bears much promise for the future.

“…20 In balloon kyphoplasty, [21][22][23] the balloons create only a cave and the tumour cells are only pushed to the side, which increases the risk of tumour spread to blood vessels. Even in the radiofrequency kyphoplasty, [24][25][26][27] the tumour is not removed and only deported by the bone cement to the side, where there is also the risk of tumour spread through the blood vessels. In both methods, there occurs no removal of the tumour tissue.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of tumours and metastases of the spine by minimally invasive cavity-coblation method

Dabravolski

Eßer

J Orthop Surg (Hong Kong)

et al. 2017

Tumours and metastases of the spine are extremely stressful for patients, especially for elderly multimorbid patients. The modern cavity/coblation method offers a very good therapeutic alternative for such patients. The goal of this article was to evaluate and present the characteristics, significance, opportunities, issues of the minimum invasive cavity/coblation method as well as the results of the treatment of 302 patients with vertebral tumours and metastases.