Anterior epidural carbon dioxide dissection during spine cryoablation

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.

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).

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.

CO₂ dissection of the anterior epidural space was successful in all 3 procedures allowing complete treatment on all post-ablation MRI.