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.


TERMINOLOGY


Synonyms



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


Definitions



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


PRE-PROCEDURE


Indications



  • 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


PROCEDURE


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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