Vertebral Augmentation, T4

Pre-op AP

Vertebral compression fracture in the T4 vertebra. Compression on one side of the vertebral body.

Pre-op lateral

Vertebral compression fracture in T4.

Intra-op AP

Cavity creation toward the compressed side of the vertebral body using the VertecoR® MidLine Osteotome.

Intra-op Lateral

Cavity creation across the midline of the vertebral body using the VertecoR® MidLine Osteotome.

Intra-op AP

Cavity creation directed superiorly using the VertecoR® MidLine Osteotome.

Intra-op Lateral

Cavity creation directed superiorly using the VertecoR® MidLine Osteotome.

Intra-op AP

Cement fill into the contralateral side of the vertebral body via a unipedicular approach.

Intra-op Lateral

Targeted placement of StabiliT ER2 Bone Cement.

Vertebral Augmentation, L5

Intra-op Lateral

Targeted channel created across the midline to level of contralateral pedicle created with the VertecoR®MidLine Osteotome

Intra-op AP

Targeted channel created across the midline to level of contralateral pedicle created with the VertecoR®MidLine Osteotome

Intra-op Axial

Cavity created across the midline of the vertebral body using the VertecoR® MidLine Osteotome.

Intra-op Axial

Cavity created across the midline of the vertebral body using the VertecoR® MidLine Osteotome.

Post-op AP

Controlled and preferential cement flow results in cement across the midline and site-specific delivery.

Post-op AP

Controlled and preferential cement flow results in cement across the midline and site-specific delivery.

Vertebral Augmentation, L3

Image 1

Vertebral body is accessed transpedicularly using only a single pedicle.

Image 2

Unipedicular access into the middle 1/3 of the vertebral body using the StabiliT Introducer.

Image 3

Created a targeted channel across the midline to the contralateral pedicle with the VertecoR MidLine Osteotome.

Image 4

Created a targeted channel across the midline to the contralateral pedicle with the VertecoR MidLine Osteotome.

Image 5

Targeted StabiliT ER2 Bone Cement delivery into targeted channels created in the vertebral body using the VertecoR MidLine Osteotome

Image 6

Targeted StabiliT ER2 Bone Cement delivery into targeted channels created in the vertebral body using the VertecoR MidLine Osteotome

Image 7

Controlled and preferential cement flow results in cement across the midline and site-specific delivery.

Image 8

Controlled and preferential cement flow results in cement across the midline and site-specific delivery.

Vertebral Augmentation, L3, L5

StabiliT Introducer placement into L3 and L5

StabiliT Introducer placement into L3 and L5

Intra-op Lateral

Targeted cavity creation in L3 using the VertecoR Midline Osteotome.

Intra-op AP

Cavity creation across the middle of L3 using the VertecoR MidLine Osteotome.

Intra-op AP

Cavity creation across the midline of L5 using the VertecoR MidLine Osteotome.

Post – Op lateral

Anterior, superior and inferior delivery StabiliT Bone Cement into L3 (picture on the right, upper level). Note the cement in the superior-anterior quadrant followed the preferential path created by the VertecoR MidLine Osteotome (picture on the left).

Post – Op AP

Targeted delivery of StabiliT Bone Cement in L5 (bottom level)

Vertebral Augmentation

Case Image 1

Dr. Conrad created a targeted cavity beneath the fracture line in order to preferentially deliver cement into the inferior aspect of the vertebrae and adjacent trabecular bone prior to filling the fracture plane in order to avoid extravasation. StabiliT Bone Cement delivered precisely as planned.

Case Image 2

Case Image 2

Case Image 3

Case Image 4

Note the interdigitation in the lower part of the vertebral body. StabiliT Bone Cement filled the fracture line prior to filling the compromised area beneath the superior endplate as planned.

t-RFA, L4 Metastatic Lesion

Pre-op CT Axial

Pre-op CT axial image of L4 with a destructive, posterior vertebral body lesion. Pre-op CT images used to plan access, size, and shape of desired ablation zone.

Instrument Placement

The Working Cannula of the coaxial STAR™ System was docked at anterior aspect of right pedicle. Articulation of the SpineSTAR instrument allows navigation to center of the metastatic lesion in posterior aspect of vertebra. The SpineSTAR®’s insulator, identified as the radiolucent region area near distal end of the instrument, represents center of ablation zone.

Procedure

Ablation was performed at power level 1 (5W) until the distal thermocouple registered 50ºC, representing the predetermined desired ablation zone of ~20 mm long by ~14 mm wide. Total ablation time was 2:30 minutes. Patient reported post procedure pain relief. No complications or thermal injury occurred.

One Month Post Procedure

MRI images demonstrated the lesion was included within a discrete ablation zone.

One Month Post Procedure

MRI images demonstrated the shape of ablation zone consistent with the expected 3:2 length/width aspect ratio. Temperature displayed on MetaSTAR® Generator during ablation permitted real-time monitoring of ablation zone size based location of the SpineSTAR thermacouples in the vertebral body.

One Month Post Procedure

Post-contrast T1 images demonstrating ablation zone (thin arrows) and necrosis of lesion with minimal enhancement posteriorly.

t-RFA, L5 Metastatic Lesion

Pre-op CT Axial

Pre-op CT axial image of L5 vertebra with a destructive, posterior vertebral body lesion. Pre-op CT images used to plan access, size, and shape of desired ablation zone. Two adjacent ablations were planned to ensure coverage of the entire lesion.

Instrument Placement

Transpedicular intra-op navigation of SpineSTAR® instrument performed under flouroscopic guidance to position across midline in the posterior aspect of the L5 vertebra for first of two ablations.

Procedure

Two ablations were performed during which the SpineSTAR was articulated to adjacent areas. Patient reported post procedure pain relief. No complications or thermal injury occurred.

One Month Post Procedure

One month post procedure: MRI demonstrates clearly demarcated ablation zones in L5. The periphery of the ablation zones are again identified by the reactive zone at the periphery of the two overlapping zones. The combination of targeted ablation zone and navigation permits larger areas to be treated.

One Month Post Procedure

Contrast MRI confirms distinct ablation zone / necrosis of lesion with minimal enhancement posteriorly in L5.