BACKGROUND AND PURPOSE: Combining percutaneous plasma-mediated radio-frequency 
(pmRF) ablation with vertebral body augmentation offers an alternative treatment 
to surgical intervention options for advanced metastatic spinal lesions and is 
particularly useful for cases with cortical destruction and/or epidural 
extension. This study evaluates bone cement deposition patterns and 
extravasation in treated vertebral bodies in relation to the metastatic lesion 
after using this combined approach.
MATERIALS AND METHODS: Retrospective assessments of CT images performed 
before/after the procedures were evaluated in 37 patients (44 levels) with 
advanced metastatic lesions. A void was created in the anterior portion of the 
tumor-infiltrated vertebral body by using a bipolar plasma-mediated 
radio-frequency-based wand, followed by deposition of bone cement. Pain measured 
by visual analog scale score was recorded preprocedure and 2-4 weeks afterward.
RESULTS: In 19 (43%) levels, 90%-100% of the cement was deposited in the 
anterior two thirds of the vertebral body. In 34 levels (77%), 75% or more of 
the cement was deposited in the anterior two thirds of the vertebral body. In 
13/15 (86%) levels with posterior lesions, cement was deposited anterior to the 
lesion. No extravasation was observed in 13 levels (29.5%). Two clinically 
insignificant incidences of epidural extravasation were noted. Pain relief after 
the procedure was reported by 25/28 (89.5%) patients with available data.
CONCLUSIONS: pmRF ablation may allow greater cement-deposition control, 
increasing the likelihood of successfully stabilizing the anterior two thirds of 
the vertebral body. This combined technique appeared particularly useful in 
cases with posteriorly located lesions. The incidence of cement extravasation 
was relatively high but clinically insignificant.