Cavity Spinwand

Cavity Spinwand

Donald V. La Barge, III, MD

Clinical photograph depicts Cavity SpineWand. A power source plugs into the back of the handle, and a saline flush attaches to the sidearm image. A connector image attaches the device to the pedicle access needle.

Lateral fluoroscopic spot radiograph after SpineWand Coblation shows cavity created by SpineWand, depicted by 0.035″ Bentson wire image. Bipedicular 8-gauge access needles are in place image.



  • Coblation (ArthroCare; Sunnyvale, California), tumor debulking void-enhanced vertebroplasty


  • Cavity creation via plasma field ablation of vertebral body neoplasms prior to cement injection/vertebral augmentation



  • Primary or metastatic spinal tumor ± pathological fracture

Getting Started

  • Things to check

    • Pre-procedure imaging

      • Cortical breakthrough/epidural extension of tumor

      • Assessment of relevant anatomy/satisfactory pedicle integrity for access

    • Pre-procedure pain scale

    • Informed consent

  • Medications

    • Antibiotics immediately before procedure (1 g of cefazolin sodium, if not contraindicated)

  • Equipment list

    • Radiopaque marker

    • Standard prep and drape materials

    • Local anesthetic

    • 22-gauge spinal needle if needed to anesthetize pedicle

    • Vertebral access needle adequate to permit passage of Cavity SpineWand (ArthroCare; Sunnyvale, California) (8- or 11-gauge)

    • Bone biopsy needle

    • Cavity SpineWand and associated equipment to include saline flush

    • Bone cement and injector


Patient Position/Location

  • Best procedure approach

    • Prone

Equipment Preparation

  • Ensure proper functioning of Cavity SpineWand power generating system

  • Ipsilateral oblique will show ovoid pedicle; stop oblique where maximal pedicle size is seen (“down the barrel” view)

    • Biplane fluoroscopy is ideal, enabling 1 tube to provide direct lateral fluoroscopy at all times

Procedure Steps

  • “Time out” with all team members present

    • Proper patient, procedure, and level(s) to be intervened upon

  • Ensure correct spinal level(s), and mark skin

  • Initiate conscious sedation

  • Provide local anesthetic

    • Use of 22-gauge spinal needle is advantageous in many cases to anesthetize pedicle cortex

  • Guide access needle to pedicle cortex (using “down the barrel” ipsilateral oblique view)

    • Check lateral fluoroscopy prior to anchoring needle to ensure accurate trajectory

    • Ensure that needle trajectory will not violate medial pedicle cortex on AP/oblique view

  • Anchor access needle in pedicle cortex, and recheck trajectory

  • Under intermittent AP and lateral fluoroscopy, advance needle to vertebral body to permit accurate biopsy and Cavity SpineWand placement within tumor

  • Perform percutaneous vertebral biopsy

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Sep 22, 2016 | Posted by in EMERGENCY RADIOLOGY | Comments Off on Cavity Spinwand
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