Management of Spinal Bone Metastases With Radiofrequency Ablation, Vertebral Reinforcement and Transpedicular Fixation: A Retrospective Single-Center Case Series

Abstract

Spine is a frequent site of bone metastases, with a 8.5 months median survival time after diagnosis. In most cases treatment is only palliative. Several advanced techniques can ensure a better Quality of Life (QoL) and increase life expectancy. Radiofrequency ablation (RFA) uses alternating current to produce local heating and necrosis of the spinal lesion, preserving the healthy bone. RFA is supported by vertebral reinforcement through kyphoplasty and vertebroplasty in order to stabilize the fracture with polymethylmethacrylate (PMMA) injection, restoring vertebral body height and reducing the weakness of healthy bone. The aim of this study is to demonstrate the efficacy and advantages of RFA plus vertebral reinforcement through PMMA vertebroplasty and fixation in patients affected by bone spinal metastases. We retrospectively analyzed 54 patients with thoraco-lumbar metastatic vertebral fractures admitted to our Unit between January 2014 and June 2020. Each patient underwent RFA followed by PMMA vertebroplasty and transpedicle fixation. We evaluated pain relief through the Visual Analogue Scale (VAS) Score and PMMA vertebral filling based on the mean Saliou filling score. Analysis of variance (ANOVA) was used to test pain relief with statistical significance for p<0.05. A total of 54 patients (median age 63,44 years; range 34-86 years), with a total of 63 infiltrated vertebrae, were treated with RFA, PMMA vertebroplasty and transpedicular screw fixation; average operative time was 60.4 min (range 51–72). The preoperative average VAS score decreased significantly from 7.81 to 2.50 (p < 0.05) after 12 months. Based on Saliou filling score, filling was satisfactory (12–18) in 20 vertebrae (31,7%), mediocre (6–11) in 33 vertebrae (52,4%), inadequate (0–5) in 10 vertebrae (15,9%). A consistent PMMA filling of vertebral bodies was successfully achieved with significant pain relief. Concomitant RFA, PMMA vertebroplasty and pedicle screw fixation represent a safe and effective technique for the management of spinal metastases, improving clinical outcome and pain control.

Percutaneous CT-Guided Microwave Ablation Combined with Pedicle Screw Fixation Followed by Vertebroplasty (MASFVA): Initial Experience of a Minimally Invasive Treatment of Vertebral Metastases with Extension to the Vertebral Pedicle

“…However, vertebroplasty usually has a limited role in mechanical support and is not effective in treating unstable spinal metastases that extend to the posterior elements, and posterior instrumentation must be inserted to stabilize the spine due to advanced cancerrelated instability [25]. Giammalva et al studied a combined approach with radiofrequency ablation and vertebroplasty followed by screw fixation, determining it a safe and effective technique for the treatment of metastases to the spine, but with a lower mean VAS pain score at 3 months after the procedure compared to our study (3.35 vs. 0.6) [26].…”

The role of radiation therapy in the treatment of spine metastases from hepatocellular carcinoma: a systematic review and meta-analysis

“…7 In patients with uncomplicated spine metastases, poor performance status, or limited life expectancy, radiotherapy represents a therapeutic cornerstone, with positive benefit-risk balances compared to surgery or percutaneous ablation. 10,36 Postradiotherapy outcomes vary widely, and postradiation VCFs may occur. Newer SRT protocols and patient-tailored dose planning seem to correlate with improved functional outcomes and LC, 16,29,33 similarly to other lesions benefitting from a stereotactic approach.…”

Radiofrequency Ablation in Vertebral Body Metastasis with and without Percutaneous Cement Augmentation: A Systematic Review Addressing the Need for SPINE Stability Evaluation

“…Thoracic vertebrae are the most common localization of VBM, accounting for 70% of the cases, followed by lumbosacral (22%) and cervical vertebrae (8%), mainly deriving from hematogenous spreads in the Batson’s vertebral venous plexus. VBM represent a secondary cause of death in the US with a median overall survival after surgery of 8.5 months, with colon, breast, prostate, thyroid, renal cell, lung, and skin cancers as the main primitives [ 2 , 3 ]. Clinical presentation is heterogeneous, with symptoms varying from back pain and functional limitation to metastatic spinal cord compression (MSCC) with potentially permanent neurological deficit resulting from collapse or fracture of the affected vertebral body [ 1 ].…”

“…Clinical presentation is heterogeneous, with symptoms varying from back pain and functional limitation to metastatic spinal cord compression (MSCC) with potentially permanent neurological deficit resulting from collapse or fracture of the affected vertebral body [ 1 ]. The pathogenesis of back pain in VBM is multifactorial and still the object of debate, resulting from a combination of vertebral body instability, local release from tumor cells of pro-inflammatory cytokines with osteoclast activity augmentation, and involvement of periosteal nerve endings [ 2 ].…”

“…However, RFA alone could alter the biomechanics and microanatomy of the vertebral body, thus increasing the risk of post-procedure vertebral fractures and spine instability. Concomitant vertebral reinforcement procedures such as percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are meant to support ablative techniques as RFA, providing stabilization of the vertebral body and restoring vertebral height [ 2 ].…”