Coblation vertebroplasty for complex vertebral insufficiency fractures
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Coblation to create a cavity in the affected vertebral body was performed for complex fractures and/or when there was a posterior wall defect. This permitted a low-pressure injection and potentially reduces the risk of extravasation of cement into the spinal canal.
Prospective audit for outcome measures and complications allowed retrospective review of cases treated by coblation. A commercial wand inserted via a wide-bore vertebroplasty needle created a cavity before inserting cement. A visual analogue scale assessed pain and Roland Morris scoring assessed mobility.
Thirty-two coblation procedures were performed. Primary diagnoses were myeloma, metastases, osteoporosis and trauma. Outcome measures were recorded with a 56 % success rate, 6 % no change and 32 % with mixed but mainly positive results; 6 % died before follow-up. No complications were observed; in particular no patient suffered neurological damage and none have developed subsequent fractures at the treated levels.
This technique makes possible cementation of patients who would otherwise be unsuitable for vertebroplasty. The modest pain and disability improvement is partly due to our stringent criteria as well as fracture complexity. Further work will assess the efficacy of the method compared with conservative measures.
• Treatment of vertebral compression fractures with possible posterior wall defects is controversial.
• Coblation before vertebroplasty allows a low-pressure injection into fractured vertebrae.
• This technique reduces risk of extravasation of cement.
• No serious complication of our coblation procedures was observed.
KeywordsVertebroplasty Spinal fractures Multiple myeloma Metastasis Osteoporosis