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The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

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Abstract

A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.

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Acknowledgments

This work was supported by US Army Medical Research and Materiel Command Breast Cancer Research Award DAMD 17-00-1-0693. Simplex P Cement was provided by Stryker-Howmedica, Canada.

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Authors and Affiliations

  1. St. Michael’s Hospital, Orthopaedic Surgery, University of Toronto, St. Michael’s Orthopaedic Associates, 55 Queen St. East, Suite 800, Toronto, ON, Canada, M5C IR6

    Henry Ahn

  2. Orthopaedic Biomechanics Laboratory, UB19, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5

    Payam Mousavi, Sandra Roth & Cari Whyne

  3. Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5

    Joel Finkelstein

  4. Ontario Cancer Institute, Princess Margaret Hospital, Toronto, ON, Canada

    Lee Chin & Alex Vitken

Authors
  1. Henry Ahn
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  2. Payam Mousavi
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  3. Lee Chin
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  4. Sandra Roth
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  5. Joel Finkelstein
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  6. Alex Vitken
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  7. Cari Whyne
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Correspondence to Cari Whyne.

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Ahn, H., Mousavi, P., Chin, L. et al. The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine. Eur Spine J 16, 1171–1178 (2007). https://doi.org/10.1007/s00586-007-0375-1

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  • DOI: https://doi.org/10.1007/s00586-007-0375-1

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