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Semin Musculoskelet Radiol 2011; 15(2): 125-134
DOI: 10.1055/s-0031-1275595
© Thieme Medical Publishers

Fire and Ice: Percutaneous Ablative Therapies and Cement Injection in Management of Metastatic Disease of the Spine

Peter L. Munk1 , 2 , Kieran J. Murphy3 , Afshin Gangi4 , David M. Liu1 , 2 , 5
  • 1Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
  • 2University of British Columbia, Vancouver, British Columbia, Canada
  • 3Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario Canada
  • 4Department of Non-Vascular Interventional Radiology, University Hospital, University of Strasbourg, Strasbourg, France
  • 5Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
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Publication Date:
15 April 2011 (online)

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ABSTRACT

Oncology intervention is actively moving beyond simple bone cement injection. Archimedes taught us that a volume displaces its volume. Where does the tumor we displace with our cement injection go? It is no longer acceptable that we displace tumor into the venous system with our cement injections. We must kill the tumor first. Different image-guided percutaneous techniques can be used for treatment in patients with primary or secondary bone tumors. Curative ablation can be applied for the treatment of specific benign or in selected cases of malignant localized spinal tumors. Pain palliation therapy of primary and secondary bone tumors can be achieved with safe, fast, effective, and tolerable percutaneous methods. Ablation (chemical, thermal, mechanical), cavitation (radiofrequency ionization), and consolidation (cementoplasty) techniques can be used separately or in combination. Each technique has its indications, with both advantages and drawbacks. To prevent pathological fractures, a consolidation is necessary. In spinal or acetabular tumors, a percutaneous cementoplasty should be associated with cryoablation to avoid a compression fracture. The cement is injected after complete thawing of the ice ball or the day after the cryotherapy. A syndrome of multiorgan failure, severe coagulopathy, and disseminated intravascular coagulation following hepatic cryoablation has been described and is referred to as the cryoshock phenomenon.

KEYWORDS

Vertebroplasty - radiofrequency ablation - cryoablation - metastases - myeloma