Letter to the Editor
Vertebral Hemangioma: Percutaneous Minimally Invasive Image-Guided Radiofrequency Ablation

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Case 1

A 38-year-old woman presented with progressive mid-back mechanical pain for 8 months (visual analog scale [VAS] score of 9) without focal neurologic deficit. On physical examination, the left paramedian mid back was focally tender on palpation, with no mass or sensory motor deficit. Computed tomography (CT) showed a nonaggressive osteolytic lesion with “polka dotted” features involving the left inferior articular process of T8 vertebra. Magnetic resonance (MR) imaging showed the lesion to be

Case 2

A 46-year-old woman presented with progressive mechanical low-back pain for 9 months (VAS = 9) without focal neurologic deficit. On physical examination, there was focal tenderness at the lumbar L2 vertebra upon palpation without mass or sensory motor deficit. CT showed a typical “corduroy cloth” feature of the L2 vertebral body and hemangioma was diagnosed based on imaging (Fig 2). MR imaging showed complete replacement of the L2 vertebral body without pathologic fracture, involvement of

Treatment

Conservative management with analgesics resulted in minimal pain relief in both patients. Surgery was not considered as the next therapeutic approach given invasiveness, morbidity, as well as lack of spinal instability and focal neurologic deficit. Following multidisciplinary discussions, decisions were made to proceed with percutaneous RFA in both patients.

RFAs were performed with the patients under moderate sedation, using the STAR tumor RF ablation system (Merit Medical Systems, South

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A.T.’s E-mail: [email protected]

J.W.J. is a paid consultant for Merit, Stryker, Medtronic, and BTG/Boston Scientific. A.T. has not identified a conflict of interest.

Figure E1 can be found by accessing the online version of this article on www.jvir.org and clicking on the Supplemental Material tab.

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