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Safety of Thermosensor Insertion in the Midline of the Spinal Canal Anterior to the Dura: A Cadaveric Study

  • Laboratory Investigation
  • Non-Vascular Interventions
  • Published:
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Abstract

Objective

To evaluate the safety of the insertion of a blunt-tip thermosensor inside the anterior epidural space using the trans-osseous route in the dorsal spine and the double oblique trans-foraminal approach in the lumbar spine.

Materials and Methods

A total of 10 attempts were made on a 91 years old human specimen. Thermosensors were inserted under fluoroscopic guidance in the anterior part of the spinal canal using various oblique angulations. Surgical dissection was then performed to identify the position of the thermosensor and look for any injury to the dural sac or the spinal cord/cauda equina.

Results

Nine thermosensors could be deployed successfully in the anterior part of the spinal canal from Th8 to L5 while one attempt (L5 level) failed due to a technical issue on the coaxial needle. On anteroposterior projection, the tip of thermosensor relative to the midline was classified as centered in 5 cases, overcrossing in 3 cases and undercrossing in 1 case. At surgical dissection, the tip of the thermosensor was epidural posterior to the posterior longitudinal ligament in 8 cases and anterior to the longitudinal ligament in 1 case (the undercrossing case). There were 3 tears to the dura, all in the overcrossing group. There was no case of injury to the spinal cord/cauda equina.

Conclusion

Insertion of a thin blunt-tip thermosensor with optimal angulation leads to an epidural post-ligamentous position on the midline without damage to the dural sac. The blunt-tip did not prevent from dural tearing should the insertion overcross the midline.

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References

  1. Tomasian A, Gangi A, Wallace AN, Jennings JW. Percutaneous thermal ablation of spinal metastases: recent advances and review. AJR Am J Roentgenol. 2018;210(1):142–52. https://doi.org/10.2214/AJR.17.18205.

    Article  PubMed  Google Scholar 

  2. Tsoumakidou G, Koch G, Caudrelier J, et al. Image-guided spinal ablation: a review. Cardiovasc Intervent Radiol. 2016;39(9):1229–38. https://doi.org/10.1007/s00270-016-1402-6.

    Article  PubMed  Google Scholar 

  3. Huntoon K, Eltobgy M, Mohyeldin A, Elder JB. Lower extremity paralysis after radiofrequency ablation of vertebral metastases. World Neurosurg. 2020;133:178–84. https://doi.org/10.1016/j.wneu.2019.09.163.

    Article  PubMed  Google Scholar 

  4. Westbroek EM, Goodwin ML, Hui F, Khan MA, Sciubba DM. Thermal injury to spinal cord, a rare complication of percutaneous microwave spine tumor ablation: Case report. J Clin Neurosci. 2019;64:50–4. https://doi.org/10.1016/j.jocn.2019.03.018.

    Article  PubMed  Google Scholar 

  5. Nakatsuka A, Yamakado K, Maeda M, et al. Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol. 2004;15(7):707–12. https://doi.org/10.1097/01.rvi.0000133507.40193.e4.

    Article  PubMed  Google Scholar 

  6. Adachi A, Kaminou T, Ogawa T, et al. Heat distribution in the spinal canal during radiofrequency ablation for vertebral lesions: study in swine. Radiology. 2008;247(2):374–80. https://doi.org/10.1148/radiol.2472070808.

    Article  PubMed  Google Scholar 

  7. Zhang C, Han X, Douglas P, Dai Y, Wang G. Bipolar radiofrequency ablation of spinal tumors: the effect of the posterior vertebral cortex defect on temperature distribution in the spinal canal. AJNR Am J Neuroradiol. 2018;39(1):E1–2. https://doi.org/10.3174/ajnr.A5393.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Nakatsuka A, Yamakado K, Takaki H, et al. Percutaneous radiofrequency ablation of painful spinal tumors adjacent to the spinal cord with real-time monitoring of spinal canal temperature: a prospective study. Cardiovasc Intervent Radiol. 2009;32(1):70–5. https://doi.org/10.1007/s00270-008-9390-9.

    Article  PubMed  Google Scholar 

  9. Kastler A, Krainik A, Sakhri L, Mousseau M, Kastler B. Feasibility of real-time intraprocedural temperature control during bone metastasis thermal microwave ablation: a bicentric retrospective study. J Vasc Interv Radiol. 2017;28(3):366–71. https://doi.org/10.1016/j.jvir.2016.09.030.

    Article  PubMed  Google Scholar 

  10. Lecigne R, Cazzato RL, Dalili D, Gangi A, Garnon J. Transosseous temperature monitoring of the anterior epidural space during thermal ablation in the thoracic spine. Cardiovasc Intervent Radiol. 2021;44(6):982–987. https://doi.org/10.1007/s00270-021-02771-y

    Article  PubMed  Google Scholar 

  11. Groetz SF, Birnbaum K, Meyer C, et al. Thermometry during coblation and radiofrequency ablation of vertebral metastases: a cadaver study. Eur Spine J. 2013;22(6):1389–93. https://doi.org/10.1007/s00586-012-2647-7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bornemann R, Grötz SF, Pennekamp PH, et al. Radiofrequency ablation: temperature distribution in adjacent tissues. Radiofrequenzablation: Temperaturverteilung im angrenzenden Gewebe. Z Orthop Unfall. 2016;154(3):294–298. doi: https://doi.org/10.1055/s-0042-103930

  13. Lecigne R, Garnon J, Cazzato RL, et al. Transforaminal Insertion of a Thermocouple on the Posterior Vertebral Wall Combined with Hydrodissection during Lumbar Spinal Radiofrequency Ablation. AJNR Am J Neuroradiol. 2019;40(10):1786–1790. https://doi.org/10.3174/ajnr.A6233

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Salzer J, Granåsen G, Sundström P, Vågberg M, Svenningsson A. Prevention of post-dural puncture headache: a randomized controlled trial. Eur J Neurol. 2020;27(5):871–7. https://doi.org/10.1111/ene.14158.

    Article  CAS  PubMed  Google Scholar 

  15. Chiapparini L, Sghirlanzoni A, Pareyson D, Savoiardo M. Imaging and outcome in severe complications of lumbar epidural anaesthesia: report of 16 cases. Neuroradiology. 2000;42(8):564–71. https://doi.org/10.1007/s002340000359.

    Article  CAS  PubMed  Google Scholar 

  16. Bartos A, Breazu CM, Bartos D, Mitre CI. Accidental spinal cord injury following an attempted thoracic epidural for acute pancreatitis pain management. Turk J Anaesthesiol Reanim. 2020;48(1):71–4. https://doi.org/10.5152/TJAR.2019.15564.

    Article  PubMed  Google Scholar 

  17. Cazzato RL, Proust V, Garnon J, et al. Acute bilateral decrease in vision acuity following cryoablation of a painful L5 spinal metastasis. Cardiovasc Intervent Radiol. 2021. https://doi.org/10.1007/s00270-021-02924-z.

    Article  PubMed  Google Scholar 

  18. Nagel SJ, Reddy CG, Frizon LA, et al. Spinal dura mater: biophysical characteristics relevant to medical device development. J Med Eng Technol. 2018;42(2):128–39. https://doi.org/10.1080/03091902.2018.1435745.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l’Hôpital, 67096, Strasbourg Cedex, France

    Julien Garnon, Melissa Fesselier, Pierre Auloge, Roberto Luigi Cazzato, Guillaume Koch & Afshin Gangi

  2. Department of Neurosurgery, Hôpital de Hautepierre, 1, place de l’Hôpital, 67096, Strasbourg Cedex, France

    Irène Olivier

  3. Department of Radiology, Hôpital Sud, 16, Boulevard de Bulgarie, 35200, Rennes, France

    Romain Lecigne

  4. Nuffield Orthopaedic Centre, King’s College Hospital NHS Foundation Trust, Strand, London, WC2R 2LS, UK

    Danoob Dalili

  5. Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, St Louis, MO, 63110, USA

    Jack Jennings

Authors
  1. Julien Garnon
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  2. Irène Olivier
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  3. Romain Lecigne
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  4. Melissa Fesselier
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  5. Danoob Dalili
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  6. Pierre Auloge
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  7. Roberto Luigi Cazzato
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  8. Jack Jennings
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  9. Guillaume Koch
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  10. Afshin Gangi
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Corresponding author

Correspondence to Julien Garnon.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This study has obtained IRB approval from the department of Anatomy of the University Hospital of Strasbourg and the need for informed consent was waived.

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Garnon, J., Olivier, I., Lecigne, R. et al. Safety of Thermosensor Insertion in the Midline of the Spinal Canal Anterior to the Dura: A Cadaveric Study. Cardiovasc Intervent Radiol 44, 1986–1993 (2021). https://doi.org/10.1007/s00270-021-02962-7

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  • DOI: https://doi.org/10.1007/s00270-021-02962-7

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