Minimally invasive surgical treatment of tumors and metastases of the spine by plasma field therapy (Cavity-Coblation method)

Abstract

Background: Tumours and metastases of the spine are extremely stressful for patients. A radical surgery of metastases of the spine is not possible in many cases. Especially higher risk elder multimorbid patients are at risk. The therapeutic goals are always: small invasiveness, high efficiency of tumour removal, fracture repositioning, stabilisation, pain reduction, improving the patient's life quality. The specialness and difficulties of the diagnosis and therapy with the Cavity/Coblation-method the operative technique, results of the treatment of more than 274 patients with vertebral body tumours/metastases is going to be presented. Materials and methods: Patients: Patients of every age with destruction were treated: with osteolysis, Fractures of the spine caused by spinal tumours and metastases. Diagnosis preoperatively was evaluated through X-Ray, MRT, CT, complete body PET, histology. Cavity/Coblation method: The tumour tissue resection in the vertebra was carried out by the plasma field (T 42• C, cold energy) over the percutaneous transpedicular or extrapedicular access and was followed by vertebroplasty or balloon kyphoplasty with PMMA bone cement. This was followed up with clinical and radiological examinations, including data concerning pain and improvement of life quality after 2, 14 days as well as 3, 6, 12, 24, 36, 48 and 60 months postoperatively. Results: Within 6 years (03/08-04/14) more than 274 patients (171 female, 103 male, age range of 31-92 y. old average age of 65.7) or 895 vertebral bodies with tumours or metastases were treated. In 61 cases of 274, dorsal percutaneous instrumentation und straightening was an additional treatment. A small amount of blood loss and a very low complication rate was recorded. Postoperatively was shown by all patients an obvious reduction of pain, increase in life quality, satisfaction with the operative result, rapid mobilization was possible as well as the immediate radiation and chemotherapy for reduction of the local tumour recurrence rate. The complications were as follows: in 39 cases of 274 a cement leakage occurred laterally or in the intervertebral disc space without clinical relevance. 194 patients (105 women, 89 men) are now deceased due to tumour manifestations. Conclusions: Coblation/Cavity has shown itself to be a safe, minimal invasive procedure with good short and long term results, a low complication rate, blood loss and short surgery times. The total local recurrence rate for all patients with spine metastases in the study was in 35 from 250 cases/patients with metastasen or only in 14.0%. Following things are important: a comprehensive diagnostic including tumour staging, correct indication, prognostic assessment and precise surgical technique. The method bears much promise for the future.