Purpose Spinal metastatic lesions which are located in the anterior or posterior regions of the vertebral body (Weinstein types III and IV) are usually treated by extensive anterior corpectomy stabilization and posterior fusion. This study assesses the value of creating a cavity in the anterior two-thirds of the vertebral body using plasma mediated radiofrequency ablation prior to cement injection, aiming to stabilize the anterior column through a non-heat-driven method.

Materials and methods Retrospective assessments of CT images were performed pre- and postprocedure in 24 patients (27 levels). A void was created in the anterior portion of the tumor infiltrated vertebral body using a bipolar plasma mediated radiofrequency based wand (ArthroCare Corporation, Austin, Texas, USA) and bone cement was inserted. Pain was recorded both preprocedure and 2–4 weeks afterwards using a visual analog scale (VAS).

Results In 11/12 levels with anterior lesions, cement was deposited inside the lesion. Cement was also successfully deposited anterior to the lesion in 13/15 levels with posteriorly located lesions. VAS pain scores were available for 21 patients: 19 reported significant pain relief while two exhibited no change. No clinically significant leakage was observed.

Conclusion Cavity creation using plasma mediated radiofrequency ablation can be performed percutaneously before standard vertebroplasty and results in more control over cement deposition in the anterior part of the vertebral body, regardless of the lesion location. This approach could treat focal metastatic lesions while avoiding the more invasive standard technique of extensive anterior surgical debulking and reconstruction. In cases displaying neurological deficit, it can complement a simpler posterior decompressive laminectomy and fusion.