Complications

As mentioned previously, care should be taken to avoid freezing of any nearby neurovascular structures and the skin. Careful monitoring of the ice ball during the procedure should prevent these complications. Large vessels may act as a heat sink protecting both themselves and adjacent structures. If nerves are inadvertently incorporated into the periphery of the ice ball, where the temperature is greater than -20°C, a temporary neuropraxia may develop, which should resolve with time. If in the center of the ice ball, where temperatures of -40°C or lower predominate, permanent neurological damage may result (25). With large tumors that engulf adjacent nerve roots as can be the case with sacral tumors, this may be an acceptable risk. The patient should be made aware of the possible side effects, and a decision to proceed made after a careful evaluation of the risks and benefits.

Other possible complications include postprocedural pain, postablation syndrome and, in the case of intraosseous lesions, fracture. Although ice is known to have an anesthetic effect, temporary postprocedural pain exacerbation is still possible with the larger lesions. Postablation

FIGURE 5 Metastatic rectal adenocarcinoma to the sacrum unresponsive to radiation and chemotherapy. The patient had severe pain uncontrolled by medication.

FIGURE 6 Axial computed tomography image taken during cryoablation of the tumor demonstrated in Figure 5. There was temporary relief of pain with no serious neurological sequalae, although the patient later succumbed to the disease.

syndrome is marked by transient symptoms including fever and generalized malaise. These symptoms are most likely mediated by systemic release of toxins from necrotic tumor, and there is an increased incidence of this syndrome in cases involving large ablation volumes (31). There is mention in the literature of fractures in the periprocedure period in ablations of intraosseous lesions. Many of these reports are in patients who underwent open intralesional curettage and cryoablation, although there are anecdotal reports of this complication in percutaneous treatments where probes were introduced into the medullary cavity. In such cases, it may be advisable to combine treatment with surgical instrumentation of the area for purposes of stabilization (32,33).

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Dealing With Back Pain

Dealing With Back Pain

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