CIO 2021-25 Review of Percutaneous Ablation of Spinal Tumors

Purpose: The focus of this educational exhibit is to present a concise review of percutaneous ablation of spinal tumors.

Material and Methods: We present a review of percutaneous ablation and its utility in treating spinal tumors. A concise literature review in both text and figure form will detail the supporting data, patient selection, technique, and potential complications.

Results: Patients with small, painful primary bone tumors or rare benign but locally aggressive tumors (i.e. aneurysmal bone cyst and giant cell tumor) may be treated with curative intent with spinal tumor ablation. Metastatic lesions are the most common indication either in the setting of oligo-metastatic or oligo-progressing disease or as palliation to reduce spinal cord compression from extraspinal compression. Preprocedural computed tomography is acquired to evaluate for interval tumor changes and variant vessel anatomy. A trans-osseous approach should be performed as extrapedicular coaxial bone access into the vertebral body may be complicated by variable origins of the great anterior radiculomedullary artery. Accessing the anterior epidural space through a trans-foraminal approach should be done to avoid foraminal neurovascular structures that lie just above. Blastic bone may cause high resistance, so interventionalists may elect to use a drill to penetrate the bone. Ablation of the lesion is completed with consideration of the adjacent structures. If the target lesion suboptimally absorbs energy, a few drops of 0.9% saline may be injected into the area to circumvent high tumor impedance, though saline injection may lead to unforeseeable ablation zones. Following ablation, all devices are withdrawn and PMMA cement is injected once the temperature within the vertebral body is physiologic. Neural damage is a relatively common complication of ablation, but is often transient. One of the more severe complications is damage to the anterior spinal circulation as it would cause irreversible and immediate anterior spinal cord ischemia with subsequent paraplegia. This risk may be mitigated by the avoiding paravertebral approach. Data reveals that ablation of bone tumors provide high local control and significantly reduces pain in patients with painful spinal metastases.

Conclusions: Despite data showing percutaneous ablation benefits patients with primary benign and metastatic bone tumors, proper patient selection, evaluation, and technique are needed to avoid complications.