Bone Cement Deposition Patterns with Plasma-Mediated Radio-Frequency Ablation and Cement Augmentation for Advanced Metastatic Spine Lesions

Georgy, Bassem

doi:10.3174/ajnr.a1548

Cited by 26 publications

(25 citation statements)

References 30 publications

(34 reference statements)

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“…To address such limitations, the coblation technique was incorporated in the minimally invasive percutaneous armamentarium for advanced metastatic vertebral compression fractures (16,17,22). Coblation is a well-established procedure in several medical specialties and is regularly used in tonsillectomies, cardiac surgeries, arthroplasty, and spine nucleotomy (19).…”

Section: Discussionmentioning

confidence: 99%

“…Plasma-mediated radiofrequency-based ablation (coblation) prior to cementoplasty was introduced to address these limitations (15)(16)(17). Coblation creates a precisely focused plasma that dissociates (ablates) molecular bonds within the contact area at relatively low temperatures (40-70°C) (18)(19)(20).…”

mentioning

confidence: 99%

“…This results in the volumetric removal of target tissue, providing a cavity that directs the cement away from the disrupted posterior vertebral wall and along a path of lesser resistance into the vertebral body ( Fig. 1) (17). In contrast to other thermal electrosurgery techniques, such as radiofrequency ablation, coblation diminishes hyperthermic cy-totoxicity, reducing the risk of damage to the spinal cord and surrounding tissues (20)(21)(22).…”

mentioning

confidence: 99%

“…Thus, coblation provides an alternative treatment option for patients who were previously considered high-risk for conventional vertebral cement augmentation therapies. However, despite its initial efficacy, there have been few reports about this technique (15,17,23).…”

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confidence: 99%

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Coblation for metastatic vertebral disease

Prologo

Buethe

Mortell

et al. 2013

Diagn Interv Radiol

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PURPOSEPlasma-mediated radiofrequency ablation (coblation) creates a cavity for directed polymethylmethacrylate deposition through molecular dissociation, providing a safe and efficacious cementoplasty for patients with high-risk, painful vertebral body metastatic disease. The purpose of this study was to retrospectively review and report details regarding the feasibility, safety, and efficacy of coblation and cementoplasty for treating painful advanced vertebral body metastatic disease. MATERIALS AND METHODSFifteen patients with painful metastatic vertebral body fractures with a posterior cortical defect and/or epidural tumor extension underwent percutaneous coblation and cementoplasty. Each patient's medical record was reviewed for technical success, imaging outcome, complications, and palliative effect. RESULTSOf the 15 cases, 14 were completed successfully. Postprocedure imaging studies demonstrated adequate cement deposition within the targeted vertebral body without cement extravasation or fracture progression during the 1-3 months follow-up period. Pain relief was achieved in all patients, and no neurological damage was reported (mean follow-up, 141.1±132.5 days). CONCLUSIONPercutaneous image-guided coblation-mediated cavity creation prior to vertebroplasty allows for safe, efficacious cement deposition in patients with metastatic foci. Future studies prospectively comparing this procedure with other standard-of-care regimens are warranted.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Coblation for metastatic vertebral disease

Prologo

Buethe

Mortell

et al. 2013

Diagn Interv Radiol

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“…In contrast to RFA, a cavity is created in the target tissue, caused by the slightly curved design of the device and its circumferential moving in different clock positions while performing coblation. The created cavity allows a more controlled injection of cement during the following vertebroplasty [9]. Recently, plasma-mediated ablation has found its way into treatment of both bone tumors and bone metastases.…”

Section: Introductionmentioning

confidence: 99%

Thermometry during coblation and radiofrequency ablation of vertebral metastases: a cadaver study

Groetz

Birnbaum²,

Meyer

et al. 2013

Eur Spine J

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Purpose To evaluate safety of coblation of simulated lytic metastases in human cadaveric vertebral bodies by measuring heat distribution during thermal tissue ablation and comparing it to radiofrequency ablation (RFA). Materials and methods Three devices were compared: a 10 mm single-needle RFA electrode, a 20 mm array RFA electrode and the coblation device. To simulate bone metastases, a spinal tumor model was used stuffing a created lytic cavity with muscle tissue. Measuring of heat distribution was performed during thermal therapy within the vertebral body, in the epidural space and at the ipsilateral neural foramen. Eight vertebral bodies were used for each device. Results Temperatures at heat-sensitive neural structures during coblation were significantly lower than using RFA. Maximum temperatures measured at the end of the procedure at the neural foramen: 46.4°C (±2.51; RFA 10 mm), 52.2°C (±5.62; RFA 20 mm) and 42.5°C (±2.88; coblation). Maximum temperatures in the epidural space: 46.8°C (±4.7; RFA 10 mm), 49.5°C (±6.48; RFA 20 mm) and 42.1°C (±2.5; coblation). Maximum temperatures measured within the vertebral body: 50.6°C (±10.48; RFA 10 mm), 61.9°C (±15.39; RFA 20 mm) and 54. 4°C (±15.77; coblation). Conclusion In addition to RFA, the application of coblation is a safe method to ablate vertebral lesions with regards to heat distribution at heat-sensitive neural spots. The measured temperatures did not harbor danger of thermal damage to the spinal cord or the spinal nerves.

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