Purpose To demonstrate the feasibility in treating primary and metastatic lesions to the cervical spine and paraspinal soft tissues using CT-guided cryoablation. To share techniques of avoiding/displacing critical structures and the role of intraprocedural neural monitoring including motor and sensory evoked potentials.
Materials and methods CT-guided cryoablation of primary and metastatic lesions involving the cervical spine performed by the authors were retrospectively reviewed. The lesions were treated with both Galil and Endocare cryoprobes. Patients were then evaluated for local tumor control, palliative relief of symptoms, neurologic complications, equipment used, techniques to avoid critical structures, neural monitoring and hospital stay length.
Results 5 patients underwent cryoablation of the cervical spine for local control of tumor, palliative pain relief, and prevent progression of the tumor to the spinal canal. Tumor types included a desmoid tumor in the posterior paraspinal soft tissues from C3-T1, metastatic renal cell cancer to C7, metastatic hepatocellular cancer to C3, radiation induced sarcoma recurrence, and a metastatic conglomerate mass in the left cervical paraspinal soft tissues secondary to paraspinal papillary thyroid cancer. Age ranged from 54–76 with 4 males and 1 female. All 5 cases used neural monitoring and total IV anaesthesia (TIVA). 2 patients used hydrodissection to protect the dermis. 2 patients used hydrodissection to move the dural sac away from the ablation site. All 5 cases demonstrated local control of tumor on follow up imaging that ranged from 3–15 months. No patients underwent adjuvant radiation after the ablation. 2 patients continued on chemotherapy due to progression at separate sites. One patient developed an expected minor Horner's syndrome. 1 case had a thermal injury to the skin. No unexpected weakness or haemorrhage occurred. Patient example: 57 year old female with a newly diagnosed desmoid which extended from C3-T2. Current standard of care would be surgical resection followed by radiation therapy. Given the size of the lesion it was felt she would need cervical stabilization and possibly a latissimus flap. The patient was referred to our service to discuss less invasive options. Myelographic dye was placed for visualization, the spinal cord was hydrodissected away from the posterior elements using and epidural catheter, and neural monitoring was used and demonstrated no changes through the case. A total of 10 probes (Galil) were used and the lesion was cryoablated for 7 min, passively thawed for 10 min and reablated for 15 min. There was no post procedure weakness, and she was discharged postprocedure day 1, back to work on day 5.
Conclusion Cryoablation is used at our institution as part of a multidisciplinary approach in patients with metastatic and primary cancer in various organ systems for both local control and palliative treatment. We present our experience to demonstrate the feasibility and techniques used in percutaneous CT-guided cryoablation of the cervical spine and paraspinal musculature. The primary goal in these cases was local tumor control but secondary goals of reducing pain and preventing progression to the spinal canal or cervical nerve roots was also accomplished.
Disclosures J. Morris: None. M. Callstrom: None.
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