Anterior epidural carbon dioxide dissection during spine cryoablation

Purpose Spine cryoablation (SC) of posterior vertebral lesions exposes to neuronal damages and incomplete treatment due to the proximity of the spinal canal. Carbon dioxide (CO2) dissection is a nerve protective method that can be used during spine cryoablation that tends to distribute in non-dependent areas. The purpose of this technical note was to expose the feasibility of anterior epidural CO2 dissection during SC in prone decubitus. Materials and methods Three consecutives patients underwent SC of metastases abutting the posterior wall of the vertebra with anterior epidural CO2 dissection. A post-ablation MRI was performed after each cryoablation to state if the treatment was complete or incomplete. Complications were reported using the Common Terminology Criteria for Adverse Events v5.0 (CTCAE). Results Peri-procedural anterior epidural injection of CO2 was successful in all 3 procedures. Treatment was considered complete on all post-ablation MRI with ablation margins encompassing the targeted metastasis. No complication according to the CTCAE was reported. Conclusion CO2 dissection of the anterior epidural space was successful in all 3 procedures allowing complete treatment on all post-ablation MRI.