Image-guided minimally invasive percutaneous treatment of spinal metastasis

Abstract

Abstract. In order to provide effective options for minimally invasive treatment of spinal metastases, the present study retrospectively evaluated the efficacy and safety of image-guided minimally invasive percutaneous treatment of spinal metastases. Image-guided percutaneous vertebral body enhancement, radiofrequency ablation (RFA) and tumor debulking combined with other methods to strengthen the vertebrae were applied dependent on the indications. Percutaneous vertebroplasty (PVP) was used when vertebral body destruction was simple. In addition, RFA was used in cases where pure spinal epidural soft tissue mass or accessories (spinous process, vertebral plate and vertebral pedicle) were destroyed, but vertebral integrity and stability existed. Tumor debulking (also known as limited RFA) combined with vertebral augmentation were used in cases presenting destruction of the epidural soft tissue mass and accessories, and pathological vertebral fractures. A comprehensive assessment was performed through a standardized questionnaire and indicators including biomechanical stability of the spine, quality of life, neurological status and tumor progression status were assessed during the 6 weeks-6 months follow-up following surgery. After the most suitable treatment was used, the biomechanical stability of the spine was increased, the pain caused by spinal metastases within 6 weeks was significantly reduced, while the daily activities and quality of life were improved. The mean progression-free survival of tumors was 330±54 days, and no associated complications occurred. Therefore, the use of a combination of image-guided PVP, RFA and other methods is safe and effective for the treatment of spinal metastases.

Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety

“…Following the review of abstracts and titles, 63 full-text articles were ordered for assessment. On full paper review, 8 non-randomised studies (3 prospective case series, 1 prospective interventional study and 4 retrospective case series) that investigated RFA alone or in combination with another treatment were identified and included for the final analysis [8,10,[14][15][16][17][18][19]. No randomised controlled trials met the inclusion criteria.…”

“…In the series by Nakatsuka et al [14], 1 out of 10 patients reported a grade II complication consistent with a transient neural damage related to the high temperature raise during RFA; such complication completely resolved 2 days after the procedure with intravenous administration of steroids. On the other hand, Yang et al [18] reported side effects related to RFA in 4 out of 25 patients (16%). Of these, two experienced contralateral lower limb pain and numbness during the procedure; however, such symptomatology spontaneously disappeared with temperature decrease after RFA (grade I complication).…”

“…The last time-point of pain assessment largely varied across studies and ranged between 1 week and 6 months. Only, Yang et al [18] reported a follow-up >6 months in all cases (range 7-15 months; mean 7.8 months). Despite such discrepancy of time intervals at which pain was evaluated, 5/8 studies reported a highly effective analgesia (mean pain reduction ranging between 4 and 5.76); 2/8 studies reported a moderate analgesia (mean reported pain reduction 3.3 and 3.8, respectively).…”

“…Despite such discrepancy of time intervals at which pain was evaluated, 5/8 studies reported a highly effective analgesia (mean pain reduction ranging between 4 and 5.76); 2/8 studies reported a moderate analgesia (mean reported pain reduction 3.3 and 3.8, respectively). Such measurements were not available in Yang et al [18].…”

ACR Appropriateness Criteria® Management of Vertebral Compression Fractures

“…Minimally invasive percutaneous image-guided techniques for the treatment of spine tumors include newer technologies, such as radiofrequency ablation (RFA) [34], cryoablation, microwave ablation, alcohol ablation, and laser photocoagulation. These modalities provide an alternative or adjunct therapeutic option for the treatment of spinal tumors beyond medical pain management, surgery, radiation therapy (RT), and standard VA. Curative ablation can be applied for the treatment of specific benign or in selected cases of malignant localized spinal tumors.…”