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Submitted by: Bassem Georgy, M.D. When common cancers, such as breast, lung or prostate spread, they frequently form secondary tumors, or metastases, in the spine. These tumors destroy both soft tissue and bone, causing significant pain and loss of strength in the spine. As a weight bearing structure, the spine can fracture when it is weakened by metastatic disease, causing excruciating pain, compression of the spinal cord, paralysis and other complications. Over 1.5 million people are diagnosed with cancer each year. The American Cancer Society estimates that 30% to 70% of the 563,700 people who annually die of cancer, have skeletal metastases, many of which will affect the spine. As they progress, vertebral compression fractures (VCFs) can make it more difficult for patients to breathe, walk, eat and sleep due to pain and the unnatural curve the spine is forced into. Often, the pain and lack of mobility make it very difficult for patients to follow through with cancer therapies and treatments recommended by their oncologists. The problem also impacts patients' families. Often left bedridden by the pain, cancer patients with vertebral compression fractures must rely on their family or other caregivers to assist with every aspect of life, including the basic tasks, such as bathing and eating. Treatment Approaches for VCF's caused by Metastatic Disease The most aggressive of the surgical options is open spinal surgery to remove the tumor tissue. The procedure carries substantial risks and due to the long recovery period associated with open surgery, not everyone is a good candidate for this treatment-especially patients in the more advanced stages of cancer who may have a limited life expectancy. Minimally invasive spine procedures like vertebroplasty and kyphoplasty, avoid the drawbacks of open surgery, while providing spine stabilization and pain relief. In these procedures, bone cement is utilized to stabilize the frail area affected by the tumor. The latest addition to technologies for spinal intervention is a plasma mediated device that can be used to create a space inside the vertebral body by reducing the malignant lesion. This "space" then allows for cement augmentation or vertebroplasty to stabilize the fracture. These treatments when used together reduce the risks of complications such as cement migrating outside the vertebral body. How the procedure works: The plasma medicated device uses Coblation® technology to treat the tumor and operates at a lower temperature and is much more precise than traditional surgical tools. Instead of exploding tissue structures under high temperatures, Coblation technology gently dissolves target tissue, minimizing damage to surrounding healthy tissue. Procedure Background Dr. Wade Wong, professor of radiology, and Dr. Bassem Georgy assistant clinical professor of radiology at the University of California, San Diego School of Medicine (UCSD) were instrumental in developing this innovative procedure. Over fifty-five patients have been treated at UCSD. Each patient had advanced cancer that had spread to the spine and was not a candidate for conventional vertebroplasty or kyphoplasty. Most patients were also not candidates for surgery. Following the treatment using the plasma-mediated device and cement augmentation the patients had marked improvement of pain and increased mobility that allowed them to continue radiation therapy or chemotherapy. Complications were minimal and mostly clinically insignificant. Eva Gerristsen, of Southern California was diagnosed with myeloma in 2006. The cancer metastasized in her spine which resulted in extreme pain. "The pain, spasms and cramps were extreme at many times. I had to stay in bed," Eva Gerritsen explained. She was referred to Dr. Georgy by her primary care physician and had the procedure in January 2007. "Now I can sit upright in a chair. Before I had the procedure done it was difficult for me to sit anyplace. The pain relief has been fantastic." Patients who have undergone the procedure typically report significant improvements in their quality of life: from being in severe pain for months prior to treatment, to much improved or even pain free. This is a key benefit as it also helps the patient to comply better with additional chemotherapy or targeted radiotherapy treatment. Another important benefit derives from treating the spinal fracture before complications set in such as spinal cord compression. Stabilizing the vertebrae early can stop the fracture from becoming a neurological emergency in the future. Patient Selection Cancer patients with metastatic or primary spinal tumors who have painful vertebral fractures may be potential candidates for this procedure which can be a powerful adjunct to other oncologic treatments. In all circumstances, the patient needs to continue oncologic and radiotherapeutic therapies as dictated by their referring physicians. While it does not replace other therapies, it has the potential dramatically decrease pain and improve quality of life. To learn more about Vertebroplasty with Coblation please visit: http://www.vertebroplasty.com/tumortreatment/ Dr. Georgy is Assistant Professor of Clinical Radiology at the University of California, San Diego School of Medicine Updated: January 20, 2009

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