Introduction: Stereotactic spinal radiosurgery (SSRS) is an important tool in the management of spinal metastasis; however, epidural tumor extension can preclude the delivery of effective doses of SSRS due to cord tolerance. Radiation fall-off results in under-dosing of the epidural component and can lead to treatment failure. To overcome this limitation we introduce the use of laser interstitial thermotherapy to destroy tumor adjacent to the spinal cord prior to SSRS. The delivery of heat is monitored in real time by thermal MR imaging. Our goal is to develop a minimally invasive procedure to be used in conjunction with SSRS to improve local control of epidural metastasis.
Methods: We selected 2 patients with high degree of epidural malignant compression (L3 and T2) who were considered poor surgical candidates and would receive SSRS without resection of the epidural tumor. Visual analog pain score (VAS) and quality of life score (QoL) were obtained before, 1 week, and 1 month after the procedure. We performed percutaneous placement of a laser probe guided with fluoroscopy and MRI based navigation in the epidural space at a distance of 6mm from the dura mater. Real time fast spin echo MR sequences co-planar with anatomical T2 images were overlaid to monitor the tissue temperature and damage in the region of interest. All patients received post-op SSRS.
Results: Median VAS was 7; 2.5; 1.5 and median QoL scores were 5%; 52.5%; 52.5% respectively at pre-op, 1- week and 1-month after treatment. All patients had improvement in the degree of spinal cord compression on imaging follow up 2 months after the procedure.
Conclusions: We present an innovative minimally invasive outpatient approach to the management of spinal metastasis; in our early experience it provided excellent local control with low morbidity and immediate improvement in pain and quality of life of our patients.
Patient Care: We present an innovative minimally invasive technique to treat spinal metastasis associated with lower surgical morbidity, achieving significant and durable improvement in pain, quality of life and local tumor control. The procedure is performed in outpatient basis, and avoids interruption or delay in iniciation of adjuvant therapy in patients with metastatic cancer.
Learning Objectives: By the conclusion of this session, participants should be able to; 1)understand the rationale for utilization of MR guided laser interstitial thermotheraphy in the management of high grade malignant spinal cord compression; 2)understand the favorable clinical outcome achieved with the technique.