Coblation for metastatic vertebral disease.

PURPOSE Plasma-mediated radiofrequency ablation (coblation) creates a cavity for directed polymethylmethacrylate deposition through molecular dissociation, providing a safe and efficacious cementoplasty for patients with high-risk, painful vertebral body metastatic disease. The purpose of this study was to retrospectively review and report details regarding the feasibility, safety, and efficacy of coblation and cementoplasty for treating painful advanced vertebral body metastatic disease. MATERIALS AND METHODS Fifteen patients with painful metastatic vertebral body fractures with a posterior cortical defect and/or epidural tumor extension underwent percutaneous coblation and cementoplasty. Each patient's medical record was reviewed for technical success, imaging outcome, complications, and palliative effect. RESULTS Of the 15 cases, 14 were completed successfully. Postprocedure imaging studies demonstrated adequate cement deposition within the targeted vertebral body without cement extravasation or fracture progression during the 1-3 months follow-up period. Pain relief was achieved in all patients, and no neurological damage was reported (mean follow-up, 141.1 ± 132.5 days). CONCLUSION Percutaneous image-guided coblation-mediated cavity creation prior to vertebroplasty allows for safe, efficacious cement deposition in patients with metastatic foci. Future studies prospectively comparing this procedure with other standard-of-care regimens are warranted.