Anterior epidural carbon dioxide dissection during spine cryoablation

Abstract

Purpose: Spine cryoablation (SC) of posterior vertebral lesions exposes to neuronal damages and incomplete treatment due to the proximity of the spinal canal. Carbon dioxide (CO₂) dissection is a nerve protective method that can be used during spine cryoablation that tends to distribute in non-dependent areas. The purpose of this technical note was to expose the feasibility of anterior epidural CO₂ dissection during SC in prone decubitus.

Materials and methods: Three consecutives patients underwent SC of metastases abutting the posterior wall of the vertebra with anterior epidural CO₂ dissection. A post-ablation MRI was performed after each cryoablation to state if the treatment was complete or incomplete. Complications were reported using the Common Terminology Criteria for Adverse Events v5.0 (CTCAE).

Results: Peri-procedural anterior epidural injection of CO₂ was successful in all 3 procedures. Treatment was considered complete on all post-ablation MRI with ablation margins encompassing the targeted metastasis. No complication according to the CTCAE was reported.

Conclusion: CO₂ dissection of the anterior epidural space was successful in all 3 procedures allowing complete treatment on all post-ablation MRI.

Keywords: Carbon dioxide; Cryoablation; Dissection; Epidural; Spine.