Combined use of percutaneous cryoablation and vertebroplasty with 3D rotational angiograph in treatment of single vertebral metastasis: comparison with vertebroplasty

Abstract

Our findings suggested that combined procedure of CVT is safe and effective for pain relief in single metastatic vertebral fractures, especially when other standard palliative treatments have failed, and improves disability. Careful needle positioning and accurate fluoroscopic and CT guidance are mandatory for a complication-free treatment.

Efficacy of Cryoablation to Control Cancer Pain: A Systematic Review

“…Both Prologo et al . and Masala et al., like Tomasian et al., demonstrated a sustained response (measured by NRS) over time.…”

Spine Cryoablation: Pain Palliation and Local Tumor Control for Vertebral Metastases

“…18 While external beam radiation remains the current standard of care for the management of painful osseous metastases, 4 percutaneous cryoablation has emerged as a safe and effective treatment option for patients with musculoskeletal tumors, refractory to radiation therapy and systemic palliative therapies including chemotherapy, hormonal therapy, bisphosphonates, and analgesics. [14][15][16][17][18][19][20][21][22][23]30 The cytotoxic effects of cryoablation are mediated through the formation of intracellular ice crystals during probemediated temperature manipulation. The crystals cause denaturation of proteins and shearing of intracellular structures, including cell membrane rupture.…”

“…However, the effectiveness of cryoablation for pain palliation and local tumor control was not discussed. 26 In a retrospective analysis of data from patients with single vertebral metastasis, Masala et al 19 described the safety and efficacy-through reduced pain (Visual Analog Scale scores) and disability (Oswestry Disability Index)-of cryoablation combined with vertebroplasty for the palliation of painful vertebral metastases, which was at least equivalent to vertebroplasty alone. However, the safety and efficacy of cryoablation as an exclusive treatment approach could not be evaluated because vertebroplasty was performed in all cases.…”

“…7 Investigators have explored several alternative strategies for the treatment of painful metastases, including minimally invasive percutaneous imaging-guided tissue ablative methods using ethanol, 8 laser-induced interstitial thermotherapy, 9 radiofrequency ablation (RFA), [10][11][12][13] and, most recently, cryoablation. [14][15][16][17][18][19][20][21][22][23] Two multicenter clinical trials have demonstrated that percutaneous RFA is effective in reducing pain due to osseous metastatic dis-ease. 12,13 Although effective at reducing pain, RFA has important limitations, including nonvisualization of the ablation margin with CT, pain associated with the procedure, and, frequently, increased pain during the immediate posttreatment period.…”

Thermoablation of Bone Tumors

“…The synergistic chemical, thermal and mechanical effects of the injected cement (generally polymethylmethacrylate, PMMA) can result in significant reduction of pain in patients with osteolytic metastases of the spine [46]. However, most studies indicate that a longer-lasting benefit resulted from combinational therapy, e. g. cryoablation plus vertebroplasty [47]. The supplemental injection of cement offers the advantage of immediate stabilization.…”