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    <title>Bipolar Radiofrequency Ablation of Spinal Tumors: The Effect of the Posterior Vertebral Cortex Defect on Temperature Distribution in the Spinal Canal | American Journal of Neuroradiology</title>  
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node57830--5" data-node-nid="57830" id="top-node-57830--6265557269" data-pisa="ajnr;39/1/E1" data-pisa-master="ajnr;ajnr.A5393" data-apath="/ajnr/39/1/E1.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Letter</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">LETTER</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Bipolar Radiofrequency Ablation of Spinal Tumors: The Effect of the Posterior Vertebral Cortex Defect on Temperature Distribution in the Spinal Canal</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">C. Zhang</span>, <span class="highwire-citation-author" data-delta="1">X. Han</span>, <span class="highwire-citation-author" data-delta="2">P. Douglas</span>, <span class="highwire-citation-author" data-delta="3">Y. Dai</span> and <span class="highwire-citation-author" data-delta="4">G. Wang</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E1-E2; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5393 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-57830--6265557269" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">C. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Bone and Soft Tissue Tumors
Tianjin Medical University Cancer Institute and Hospital
National Clinical Research Center for Cancer
Key Laboratory of Cancer Prevention and Therapy
Tianjin's Clinical Research Center for Cancer
Tianjin, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-7096-8488" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Zhang</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">X. Han </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Bone and Soft Tissue Tumors
Tianjin Medical University Cancer Institute and Hospital
National Clinical Research Center for Cancer
Key Laboratory of Cancer Prevention and Therapy
Tianjin's Clinical Research Center for Cancer
Tianjin, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=X.%2BHan%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Han%20X&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AX.%2BHan%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9066-7006" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for X. Han</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">P. Douglas </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Tianjin Medical University
Tianjin, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BDouglas%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Douglas%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.%2BDouglas%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8982-7826" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Douglas</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Y. Dai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Institute of Robotics and Automatic Information System
Tianjin Key Laboratory of Intelligent Robotics
College of Computer and Control Engineering, Nankai University
Tianjin, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BDai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dai%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BDai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-7432-226X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Dai</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">G. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Bone and Soft Tissue Tumors
Tianjin Medical University Cancer Institute and Hospital
National Clinical Research Center for Cancer
Key Laboratory of Cancer Prevention and Therapy
Tianjin's Clinical Research Center for Cancer
Tianjin, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BWang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wang%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BWang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-6549-1144" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Wang</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We read with interest the article in the June 2017 <em>American Journal of Neuroradiology</em> by Wallace et al entitled, “Percutaneous Spinal Ablation in a Sheep Model: Protective Capacity of an Intact Cortex, Correlation of Ablation Parameters with Ablation Zone Size, and Correlation of Postablation MRI and Pathologic Findings.”<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> The researchers postulated that an intact cortex appears to protect against radiofrequency ablation-induced spinal cord injury, but not against non-impedance-based modalities. This conclusion is an important consideration in the treatment of spinal metastases with bipolar radiofrequency ablation (RFA).</p><p id="p-2">In agreement with the accompanying commentary by Gemmete,<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> we believe that more animal research with bipolar RFA systems is needed, in contrast to monopolar RFA. The main limitation of the study, as Wallace et al<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a></sup> stated, is that the research was performed with normal bone, which is unlike the typical clinical situation. To strengthen the aforementioned conclusion and solve the limitation of the study, we present our preliminarily results as supportive data.</p><p id="p-3">Tumors are known to affect the posterior vertebral cortex (PVC).<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> An insulating effect of the PVC during monopolar RFA has been reported.<sup><a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> Others have postulated that RFA should only be performed on patients with an intact PVC and not too far advanced osteolysis.<sup><a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a></sup> No research regarding the effect of a PVC defect on temperature distribution during bipolar RFA in the spinal canal was found during our literature review. Thus, we performed our ex vivo research.</p><p id="p-4">A preliminarily evaluation of the temperature distribution change during bipolar RFA in the spinal canal in porcine lumbar vertebrae was performed. As shown in <a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1</a>, lumbar vertebrae from 10 pigs were collected and randomly divided into 2 groups (4 lumbar vertebrae per group). Group 1 was the intact cortex group; and group 2, the cortex defect group. The PVC defect was achieved by removal of the cortex with a rongeur. We used a radiofrequency generator connected to an expandable electrode catheter (1500X; AngioDynamics, Latham, New York) for the ablation. An infrared thermometer system (CTlaser LT; Optris, Berlin, Germany) was used to monitor the temperature. The highest temperature during RFA was recorded. RFA was performed on each sample for 15 minutes at the 75-W setting and 95°C. The temperature (37.43°C ± 4.43°C) in the intact cortex group was noted. A significant increase (49.44°C ± 3.34°C) was seen in the cortex defect group (<em>P</em> &lt; .01). Our data suggest that an intact PVC provides thermal isolation during bipolar RFA. For the cases with altered PVC, bipolar RFA is still a potentially safe therapy.</p><div id="F1" class="fig pos-float  odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/39/1/E1/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="The effect of the posterior vertebral cortex defect on temperature distribution in the spinal canal during bipolar radiofrequency ablation." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-402405091" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;The effect of the posterior vertebral cortex defect on temperature distribution in the spinal canal during bipolar radiofrequency ablation.&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/39/1/E1/F1.medium.gif" width="391" height="440"/><noscript><img class="highwire-fragment fragment-image" alt="Fig 1." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/39/1/E1/F1.medium.gif" width="391" height="440"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/39/1/E1/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/39/1/E1/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/57991" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Fig 1.</span> <p id="p-5" class="first-child">The effect of the posterior vertebral cortex defect on temperature distribution in the spinal canal during bipolar radiofrequency ablation.</p><div class="sb-div caption-clear"></div></div></div><p id="p-6">We offer these preliminary data suggesting that an intact PVC can potentially protect against RFA-induced spinal cord injury. We show changes in the temperature distribution within the spinal canal of the samples with PVC defects during bipolar RFA.</p><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-39.1.E1.1" data-doi="10.3174/ajnr.A5228"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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</li><li><span class="cit-auth"><span class="cit-name-surname">Dupuy</span>  <span class="cit-name-given-names">DE</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hong</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Oliver</span>  <span class="cit-name-given-names">B</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal</span>. <abbr class="cit-jnl-abbrev">AJR Am J Roentgenol</abbr> <span class="cit-pub-date">2000</span>;<span class="cit-vol">175</span>:<span class="cit-fpage">1263</span>–<span class="cit-lpage">66</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.2214/ajr.175.5.1751263</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>11044019</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.2214/ajr.175.5.1751263&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=11044019&amp;link_type=MED&amp;atom=%2Fajnr%2F39%2F1%2FE1.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a><div class="cit ref-cit ref-journal" id="cit-39.1.E1.5" data-doi="10.1055/s-0042-103930"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Bornemann</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Grötz</span>  <span class="cit-name-given-names">SF</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Pennekamp</span>  <span class="cit-name-given-names">PH</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Radiofrequency ablation: temperature distribution in adjacent tissues</span>. <abbr class="cit-jnl-abbrev">Z Orthop Unfall</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">154</span>:<span class="cit-fpage">294</span>–<span class="cit-lpage">98</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1055/s-0042-103930</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>27351162</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1055/s-0042-103930&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=27351162&amp;link_type=MED&amp;atom=%2Fajnr%2F39%2F1%2FE1.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2018 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 39</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 1 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jan 2018 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E1-E2; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5393 </span></div>
  
  
  
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