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

Abstract

BACKGROUND AND PURPOSE:Percutaneous cryoablation has emerged as a minimally invasive technique for the management of osseous metastases. The purpose of this study was to assess the safety and effectiveness of percutaneous imaging-guided spine cryoablation for pain palliation and local tumor control for vertebral metastases.

The Metastatic Spine Disease Multidisciplinary Working Group Algorithms

“…Percutaneous tumor ablation is performed by accessing the vertebral body under imaging guidance and generating cytotoxic temperatures that cause tumor necrosis. These procedures can be performed in an outpatient setting under conscious sedation, require minimal recovery, and do not hinder or delay adjuvant radiation or chemotherapy [12][13][14][15]. Physicians involved in the care of patients with metastatic spine disease shouldbe familiar withthese treatments andreferpatients appropriately based on best available evidence.…”

“…Percutaneous tumor ablation may be considered when spinal metastases do not respond to radiation therapy, the cumulative tolerance of the spinal cord to radiation has been reached, or inclusion criteria in clinical trials preclude radiation therapy (grade C) [12,15,[34][35][36]. In a multicenter retrospective study of spinal metastases treated with radiofrequency ablation (RFA), the local control rate was 77% (10 of 13) after median imaging follow-up of 92 days [15].…”

Current Technique and Application of Percutaneous Cryotherapy

“…It could be shown for a broad range of skeletal regions including the spinal column that both improvement of the pain score and a reduction in pain medication can be achieved in only one week [52,53]. Callstrom et al reported a reduction of the pain score on a visual analog scale from 7.1/10 prior to treatment to 4/10 after 4 weeks [53].…”

“…Some studies report an improvement over 6 months and longer [53] while other authors describe a recurrence of pain already after 3 months in individual patients [54]. Adjunctive measures, such as selective nerve blocks, can support the effect of cryotherapy in a palliative indication [52]. The combination of cryoablation in this indication with bisphosphonate therapy is advantageous since the effects are synergistic [55].…”

“…The combination of cryoablation in this indication with bisphosphonate therapy is advantageous since the effects are synergistic [55]. Complications are rare with temporary neuropathy being described most frequently in up to 6 % of cases depending on the position of the lesion [52].…”