Tumor-Ablation with Cement Augmentation

Tumor ablation with cement augmentation describes minimally invasive procedures where special probes are placed into a vertebral body containing a painful tumor in order to deliver radiofrequency (RF) energy to generate heat and treat the tumor. Spinal compression fractures associated with the tumor are treated with an additional vertebral stabilizing procedure called augmentation (Kyphoplasty or Vertebroplasty) by placing cement into the vertebral body fracture and site of the treated painful tumor.

We perform these procedures on outpatients or inpatients under conscious sedation and typically without general anesthesia. One or two large needles are placed into the vertebral body containing the painful tumor. These needles are placed from the skin with fluoroscopic (x-ray) guidance while you lie on your stomach on a special x-ray table. Special probes are then placed through the needles and safely positioned within the vertebral body with the tumor. These probes are then used to emit energy for several minutes to treat the affected area of the tumor, referred to as ablation.

Following the tumor ablation, a vertebral stabilizing procedure with cement augmentation is performed at the same setting. The same incisions are utilized for the placement of the cement. In general, Kyphoplasty uses 2 needles at the spinal level being treated while only one may be placed in Vertebroplasty.

With Kyphoplasty, a balloon is placed through each needle and inflated within the bone to create a cavity and hopefully restore some of the height loss of that vertebral body. If height is improved, the alignment of the spine may also be improved. The balloons are deflated and removed, and medical bone cement is then placed into the cavities and along the fracture line. This cement is placed through the same needles with very close fluoroscopic control. In Vertebroplasty, the cement is injected directly into the vertebral body without any balloon inflation. Both procedures work very well as treatment for compression fractures.

Spinal tumor ablation with cement augmentation procedures have potential complications which include:

1. BLEEDING.

All needle procedures have a risk of bleeding. Bleeding around the spine can push on nerve roots or the spinal cord. Patients have had to undergo emergency surgery to relieve pressure on the nerve roots and spinal cord because of bleeding after spinal needle procedures. Blood thinners such as Coumadin will be stopped prior to the procedure, and routine laboratory blood work will be done to evaluate bleeding risk.

2. INFECTION.

Any needle through the skin can introduce infection. Infection of the spinal bone is an extremely rare complication called osteomyelitis. Sterile technique will be used to minimize the risk, and additionally we will give you intravenous (IV) antibiotics just prior to the procedure to decrease the risk as well.

3. THERMAL INJURY.

The heat generated from the special probes can damage surrounding tissues beyond the tumor including adjacent nerves. Special care is made to safely position the probes for the best treatment of the tumor and to prevent any additional tissue injury.

4. NEW FRACTURE.

The large needles placed can cause a new fracture of a portion of the spine or of an adjacent rib, which can cause new symptoms. A fracture fragment may potentially displace away from the spine and push on nerve roots or the spinal cord. This rarely occurs and even more rarely requires surgery.

5. LEAKAGE OF CEMENT.

Cement may leak out of the vertebral body where it is injected. A small amount of cement leakage is not uncommon and typically does not cause symptoms. Usually the leak is into the tissues next to the bone or the adjacent disc. Cement may leak into the neural foramen (openings next to spine where nerves travel) and push on the nerves, or may leak into the spinal canal and push on the spinal cord or nerves. This pressure on the nerves or spinal cord could cause symptoms that might require emergent surgery.

6. LEAKAGE OF CEMENT INTO VEINS AND PULMONARY EMBOLUS.

The cement can also potentially leak into the nearby veins of the spine and then travel in the veins to the lungs as an embolus of cement. This process is similar to how blood clots from the legs may travel to the lungs. Although leakage into a vein is not uncommon, pulmonary embolus is rare.

7. RESPIRATORY COMPROMISE.

There have been a few deaths associated with multilevel fractures treated with Vertebroplasty and Kyphoplasty, which are felt to be the result of fat emboli to the lungs from the vertebral bone and cement. Patients with severe underlying lung disease such as COPD/emphysema may be at higher risk for this complication.

If you have any questions, please feel free to ask the physician performing the procedure prior to signing the consent.