Radiofrequency ablation of L2-L3 Facet joint osteoblastoma Kelekis, DK Filippiadis 2nd Radiology Dpt, University General Hospital “ATTIKON”, Athens/GR

CASE REPORT 18 y-o male patient reports low back pain during the last 6 months exacerbating during night time and relieved with salicylates CT scan illustrates a lesion of the left L2-L3 facet joint

CASE REPORT CT-guided percutaneous biopsy was performed Lesion was proven to be an osteoblastoma

TECHNIQUE CT-guided RFA was planned A 22 Gauge spinal needle was inserted in the epidural space and air was injected via an antimicrobial filter By means of an electronic drill a bone access needle was inserted in the lesion Coaxially a bipolar RF electrode was inserted Recording of evoked potentials was used during ablation session

TECHNIQUE A 22 Gauge spinal needle was inserted in the epidural space and air was injected via an antimicrobial filter

TECHNIQUE By means of an electronic drill a bone access needle was inserted in the lesion

TECHNIQUE Recording of evoked potentials was used during ablation session

CASE REPORT 5 years post ablation patient is pain free and bone formation is illustrated at the lesion level

Q1: Propose potential ablation modes for the treatment of osteoblastoma Radiofrequency ablation (RFA) Plasma energy ablation (coblation) Microwave ablation (MWA) Cryoablation MR-guided HIFU All the above can be used

Q1: Propose potential ablation modes for the treatment of osteoblastoma Radiofrequency ablation (RFA) Plasma energy ablation (coblation) Microwave ablation (MWA) Cryoablation MR-guided HIFU All the above can be used (RIGHT ANSWER)

Q2: Would you consider thermal protection techniques during ablation in the spine? No thermal protection is required Passive thermal protection Thermocouples Intra-operative neurological monitoring systems (neurodiagnostic EEG, EMG and evoked potential electrodes and accessories) Active thermal protection - insulation CO2, air Hydrodissection Skin warming Combination of both

Q2: Would you consider thermal protection techniques during ablation in the spine? No thermal protection is required Passive thermal protection Thermocouples Intra-operative neurological monitoring systems (neurodiagnostic EEG, EMG and evoked potential electrodes and accessories) Active thermal protection - insulation CO2, air Hydrodissection Skin warming Combination of both (RIGHT ANSWER)