RFA and Cementoplasty of Pathologic Spinal Compression Fracture

Clinical History

Here is a nice example of radiofrequency ablation and cementoplasty for stabilization of a pathologic spinal compression fracture at L3. This 52-year-old female has metastatic lung cancer and was experiencing debilitating low back pain without radiculopathy, attributable to this fracture.



Case Discussion

Sagittal and axial noncontrast enhanced CT scans reveal a mixed lytic and blastic lesion in the anterior aspect of the L3 vertebral body.  A hairline fracture is present and best seen on the axial images. A pain pump was placed previously for control of chronic bone pain arising from several additional blasting metastases.

Several fluoroscopic spot views demonstrating radiofrequency ablation using the STAR (Merit) articulating coaxial rfa needle to target the culprit lesion. 

Upon completion of the ablation, polymethylmethacrylate was instilled into the L3 vertebral body, with the final distribution as seen here. The fracture cleft is filled.  The small amount of extravasation through the superior endplate is of doubtful clinical significance. The patient’s pain was rapidly and significantly improved.


Case Credits

Images and content graciously provided by:

Jason E. Himmel, MD


References

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