J Korean Soc Spine Surg.  2016 Dec;23(4):207-215. 10.4184/jkss.2016.23.4.207.

Clinical Efficacy and Safety of Radiofrequency Ablation Therapy with Cement Augmentation for a Metastatic Spine Tumor

• Kim CS
• Kwon YH
• Chung SH
• Baek S

• KMID: 2365080
• DOI: http://doi.org/10.4184/jkss.2016.23.4.207

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To evaluate the clinical efficacy and safety of radiofrequency (RF) ablation therapy followed by a bone cement augmentation procedure in treating and managing pain among metastatic spine tumor patients. SUMMARY OF LITERATURE REVIEW: As a metastatic spine tumor is unresectable, this procedure was performed. Results showed an increase in the necrosis rate, and a decrease in local recurrence and secondary vertebral stability.
MATERIALS AND METHODS
From March 2007 to April 2016, 26 patients who were treated with RF ablation with a bone cement augmentation procedure and the same number of patients treated with radiotherapy for metastatic spine lesions were included in this study. Pain relief and functional quality of life were evaluated using a visual analogue scale (VAS) and Roland Morris Questionnaire (RMQ).
RESULTS
VAS scores preoperatively and at 1, 4, and 12 weeks follow-up were 7.45, 3.01, 3.78, and 2.97 in the procedure group, and 7.04, 6.65, 5.87, and 3.03 in the radiotherapy group. The procedure group had significantly better average outcomes than the radiotherapy group for pain relief at 4 weeks but showed no difference at 12 weeks. The RMQ score improved from 13.92 to 7.21 in the procedure group, and from 15.33 to 9.75 in the radiotherapy group. Two patients who had a metastatic tumor near the vertebral body posterior cortex showed cement leakage into the disc space, that is, intraforaminal and intracanal space; therefore, operations were performed (7.69% nerve injury).
CONCLUSIONS
RF ablation therapy with cement augmentation in treatment of metastatic spine tumor shows effectiveness in early pain relief and brings immediate vertebral stability, helping patients return to normal life. However, it carries a risk of nerve injury due to cement leakage.

Keyword

Radiofrequency ablation; Cement augmentation; Spinal metastases; Pain relief; Cement leakage

MeSH Terms

Catheter Ablation*
Follow-Up Studies
Humans
Necrosis
Quality of Life
Radiotherapy
Recurrence
Retrospective Studies
Spine*
Treatment Outcome*

Figure

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  Fig. 1. Postoperative anteroposterior (A) and lateral (B) radiographs of a 66-year-old female treated with radiofrequency ablation with vertebroplasty for uterine cancer spine bone metastasis at T6, L5, and S1. Her last follow-up anteroposterior (C) and lateral (D) radiographs 8 years later show some bone subsidence.

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  Fig. 2. Preoperative (A, B) and postoperative (C, D) anteroposterior (A) and lateral (B, C, D) radiographs of a 34-year-old male treated with radiofre-quency ablation with vertebroplasty for mesenchymal chondrosarcoma spine bone metastasis at L2, L3, S2, and S3 with an osteoclastic lesion. Leakage of bone cement into the intracanal and intraforaminal space (C) irritated the L2 and L3 nerves and induced back pain, so an L2/L3 partial laminectomy for decompression (D) was performed 28 days later.

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  Fig. 3. Preoperative (A, B) and postoperative (C, D) anteroposterior (A) and lateral (B, C, D) radiographs of a 72-year-old female treated by radiofre-quency ablation with vertebroplasty for urothelial cell carcinoma spine bone metastasis at T12, L2, L3, and L5 with an osteoblastic lesion. Leakage of bone cement into the intracanal and intraforaminal space (C, D) was noted, so T12/L1 partial laminectomy for decompression was performed just after the procedure.

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