Reconstruction of Vertebral Body After Radiofrequency Ablation and Augmentation in Dorsolumbar Metastatic Vertebral Fracture: Analysis of Clinical and Radiological Outcome in a Clinical Series of 18 Patients

Maugeri, Rosario; Graziano, Francesca; Basile, Luigi; Gulì, Carlo; Giugno, Antonella; Giammalva, Giuseppe Roberto; Visocchi, Massimiliano; Iacopino, Domenico Gerardo

doi:10.1007/978-3-319-39546-3_13

Cited by 21 publications

(14 citation statements)

References 27 publications

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“…Differently from other types of primary neoplasm, it should be highlighted that HGG is not only a neoplastic disease but, likely because of spinal cord compression by vertebral metastases, it also represents a neurological disease, since it affects the central nervous system [ 8 ]. This consideration is to be taken into account when dealing with palliative care and the end-of-life (EOL) phase of HGG patients.…”

Section: Introductionmentioning

confidence: 99%

End-of-Life Care in High-Grade Glioma Patients. The Palliative and Supportive Perspective

et al. 2018

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High-grade gliomas (HGGs) are the most frequently diagnosed primary brain tumors. Even though it has been demonstrated that combined surgical therapy, chemotherapy, and radiotherapy improve survival, HGGs still harbor a very poor prognosis and limited overall survival. Differently from other types of primary neoplasm, HGG manifests also as a neurological disease. According to this, palliative care of HGG patients represents a peculiar challenge for healthcare providers and caregivers since it has to be directed to both general and neurological cancer symptoms. In this way, the end-of-life (EOL) phase of HGG patients appears to be like a journey through medical issues, progressive neurological deterioration, and psychological, social, and affective concerns. EOL is intended as the time prior to death when symptoms increase and antitumoral therapy is no longer effective. In this phase, palliative care is intended as an integrated support aimed to reduce the symptoms burden and improve the Quality Of Life (QOL). Palliative care is represented by medical, physical, psychological, spiritual, and social interventions which are primarily aimed to sustain patients’ functions during the disease time, while maintaining an acceptable quality of life and ensuring a dignified death. Since HGGs represent also a family concern, due to the profound emotional and relational issues that the progression of the disease poses, palliative care may also relieve the distress of the caregivers and increase the satisfaction of patients’ relatives. We present the results of a literature review addressed to enlighten and classify the best medical, psychological, rehabilitative, and social interventions that are addressed both to patients and to their caregivers, which are currently adopted as palliative care during the EOL phase of HGG patients in order to orientate the best medical practice in HGG management.

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Section: Introductionmentioning

confidence: 99%

End-of-Life Care in High-Grade Glioma Patients. The Palliative and Supportive Perspective

et al. 2018

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“…Spinal metastasis affects 5−10% of patients with cancer, and about 90% of symptomatic patients suffer from severe pain due to biochemical stimulation, tumor mass effect and related pathologic fracture [26] , [35] , [36] , [37] , [38] , [39] , [40] , [41] . These patients are also at high risk of metastatic spinal cord compression caused by tumor extension and pathological fracture of vertebral bodies, resulting in decreased quality of life and shortened life expectancy [42] .…”

Section: Discussionmentioning

confidence: 99%

Thermal effect of percutaneous radiofrequency ablation with a clustered electrode for vertebral tumors: In vitro and vivo experiments and clinical application

Zhao

Peng

Chen

et al. 2018

Journal of Bone Oncology

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PurposeTo investigate effects and heat distribution of radiofrequency ablation (RFA) on vertebral tumors in vitro and in vivo swine experiments and its clinical application.Materials and methodsRFA was performed on the swine spine in vitro and in vivo for 20 min at 90 °C at the electrode tip, and the temperature at the electrode tip and surrounding tissues were recorded. Clinical application of ablation combined with vertebroplasty was subsequently performed in 4 patients with spinal tumors.ResultsIn the in vitro study, the mean temperature at the front and ventral wall of the spinal canal was 50.8 °C and 43.6 °C, respectively, at 20 mm significantly greater than 37.7 °C and 33.7 ± 1.7 °C, respectively, at 10 mm ablation depth. The coagulative necrosis area was significantly (P < 0.0001) greater at 20 mm depth than at 10 mm depth (mean 17.0 × 20.7 mm2 vs. 14.2 × 16.6 mm2). In the in vivo experiment, the local temperature increased significantly (P < 0.05) from around 36 °C before ablation to over 41 °C at 20 min after ablation, with the temperature at the electrode tip (90.4 °C) and within the vertebral body (67.0 °C) significantly (P < 0.05) greater than at the posterior (41.9 °C) and lateral wall (41.8 °C). From 2 to 5 weeks, bone remodeling began. Clinically, all four patients had successful RFA and vertebroplasty, with no neurological deficits. The pain scores were significanlty (P < 0.05) improved before (4.5–10, mean 8.0) compared with at four weeks (0–1.8, mean 1.8).ConclusionThe clustered electrode can be efficiently and safely applied in the treatment of spinal tumors without damaging the spinal cord and adjacent nerves by heat distribution.

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“…In other cases, it is combined with conventional therapies or other percutaneous treatments, e.g., cementoplasty, offering faster pain relief and bone strengthening. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

“…A multidisciplinary consultation was performed, a palliative surgery was decided and the patient was operated employing a posterior dorsal approach based on the use of radiofrequency (RF) thermoablation (MetaSTAR, Dfine, San Jose, USA), followed by the injection of polymethyl methacrylate (PMMA) in T7 and T8 vertebral body and a transpedicle fixation T5-T9. [ 13 ] The histopathological analysis of the vertebral body biopsy confirmed that the metastasis is derived from the MCC. Postoperative MRI showed a reduction of the neoplastic volume in both involved vertebral bodies (T7 and T8) [Figure 2a and b ], while a thoracic CT scan revealed the improvement of the segmental thoracic curvature with correct pedicle fixation and a partial vertebral augmentation [Figure 2c and d ].…”

Section: Case Descriptionmentioning

confidence: 92%

A thoracic vertebral localization of a metastasized cutaneous Merkel cell carcinoma: Case report and review of literature

Maugeri¹,

Giugno²,

Giammalva³

et al. 2017

Surg Neurol Int

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Background:Merkel cell carcinoma (MCC) is a rare neuroendocrine skin tumor, which may be related to sun exposure. It can metastasize to lungs, liver and bone, leading to severe morbidity and mortality. Vertebral metastases from MCC are rare. The authors report the tenth case in the literature, a 59-year-old patient with MCC, which was primarily localized in the scalp, and later provoked distant metastasis to the thoracic spinal column.Case Description:A 59-year-old woman was admitted at our Unit of Neurosurgery with a 4-month history of progressive and severe dorsal back pain, without neurological signs. The patient had been surgically treated for a recidivated MCC in the occipital region in 2007, 2011, and 2013. (In 2013, the surgical treatment also included lateral cervical lymph node dissection). Chemotherapy and radiotherapy had come after the treatments. Magnetic resonance imaging (MRI) of the dorsal spine showed metastatic vertebral involvement with cord impingement of the T7-T8 levels. A total body CT scan revealed lungs and liver metastases, besides vertebral district. After a multidisciplinary consult a palliative surgery was decided and a posterior dorsal approach was employed: Radiofrequency (RF) thermoablation was followed by the injection of cement of T7 and T8 and transpedicle fixation T5-T9. The postoperative course was uneventful and followed by a further adjuvant therapyConclusion:Spinal metastases from MCC are described in literature only exceptionally. The clinical course is presented, along with a review of literature.

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Reconstruction of Vertebral Body After Radiofrequency Ablation and Augmentation in Dorsolumbar Metastatic Vertebral Fracture: Analysis of Clinical and Radiological Outcome in a Clinical Series of 18 Patients

Abstract: Radiofrequency ablation combined with vertebroplasty seems to achieve rapid and lasting improvement in clinical symptoms in patients with malignant vertebral lesions. There was wide diffusion of PMMA in the vertebral body, with a mean cement volume of 4.5 ml.

Cited by 21 publications

References 27 publications

End-of-Life Care in High-Grade Glioma Patients. The Palliative and Supportive Perspective

End-of-Life Care in High-Grade Glioma Patients. The Palliative and Supportive Perspective

Thermal effect of percutaneous radiofrequency ablation with a clustered electrode for vertebral tumors: In vitro and vivo experiments and clinical application

A thoracic vertebral localization of a metastasized cutaneous Merkel cell carcinoma: Case report and review of literature

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