Plasma-mediated radiofrequency ablation assisted percutaneous cement injection for treating advanced malignant vertebral compression fractures

BACKGROUND AND PURPOSE: Using percutaneous cement injection to treat vertebral compression fractures (VCF) stemming from advanced malignancy, particularly those showing posterior cortical defect and epidural extension, is associated with higher risk of complications compared with treating benign osteoporotic VCF. The purpose of this study was to examine the clinical feasibility of a technique designed to improve control of cement placement. MATERIALS AND METHODS: A prospective series of patients (n = 15) with metastatic lesions having epidural extension of tumor and/or cortical disruption were treated. The percutaneous procedure consisted of using a plasma-mediated radio-frequency-based device to etch a cavity within the affected vertebral body and filling the cavity and adjacent interstices with bone cement. Change in pain status was determined by asking the patient to grade back pain preoperatively and at the 2-4-week postprocedure examination using a visual analog scale. RESULTS: An adequate amount of cement was injected in all cases. Extraosseous extension of cement was observed in 4 cases (anterior cortex, n = 3; through neural foramen, n = 1) but was clinically inconsequential. No thermal or neuronal insult was observed during the procedure in any case. Thirteen of the 15 (87%) patients reported decreased pain. CONCLUSION: Dissolution of tissue rather than displacement to create a cavity before injecting bone cement permitted well-directed cement deposition into the compromised vertebral body, which may allow a safer procedure to be conducted in patients with advanced malignant VCF. Clinical benefits may include avoiding more extensive surgery and reducing the risk of complications associated with conventional bone cement injection procedures.