Samit Patel

Three-dimensional finite element simulations of vertebral body thermal treatment (Invited Paper)

Lower back pain affects a large group of people worldwide and when in its early stages, has no viable interventional treatment. In order to avoid the eventuality of an invasive surgical procedure, which is further down the Care Pathway, an interventional treatment that is minimally invasive and arrests the patients pain would be of tremendous clinical benefit. There is a hypothesis that if the basivertebral nerve in the vertebral body is defunctionalized, lower back pain may be lessened. To further investigate creating a means to provide localized thermal therapy, bench and animal studies were planned, but to help select the applicator configuration and placement, numerical modeling studies were undertaken. A 3D finite element model was utilized to predict the electric field pattern and power deposition pattern of radiofrequency (RF) based electrodes. Three types of tissues were modeled: 1) porcine (ex-vivo), ovine (in-vivo preclinical), and 3) human (ex-vivo, in-vivo). Two types of RF devices were simulated: 1) a pair of converging, hollow electrodes, and 2) an in-line pair of spaced-apart electrodes. Temperature distributions over time were plotted using the electric field results and the bioheat equation. Since the thermal and electrical properties of the vertebral bodies of porcine, ovine, and human tissue were not available, measurements were undertaken to capture these data to input into the model. The measurements of electrical and thermal properties of cancellous and cortical vertebral body were made over a range of temperatures. The simulation temperature results agreed with live animal and human cadaver studies. In addition, the lesion shapes predicted in the simulations matched CT and MRI studies done during the chronic ovine study, as well as histology results. In conclusion, the simulations aided in shaping and sizing the RF electrodes, as well as positioning them in the vertebral body structures to assure that the basivertebral nerve was ablated, but other neighboring structures such as the spinal cord and nerve roots were spared.