Combined Treatment of a Spinal Metastasis with Radiofrequency Heat Ablation and Vertebroplasty

Abstract

1075etastatic cancer is the most common malignant disease of the skeletal system. Many of the affected patients are receiving palliative care. The first goals should be the alleviation of pain and the prevention of complications such as pathologic fractures, which is especially important in patients with spinal metastasis to avoid instability and neurologic dysfunction. The standard treatments include radiation therapy, surgery, chemotherapy, hormone therapy, and, recently, therapy using systemic radiopharmaceuticals and biphosphonates; radiotherapy remains the treatment of choice. However, the long-term results of these treatments are not fully satisfying; an effective, minimally invasive local therapy that can be performed at a single outpatient setting would be beneficial [1].We are aware of only four patients whose spinal metastases have been treated with a combination of radiofrequency heat ablation and vertebroplasty [2]. To our knowledge, ours is the first report on the successful use of combined radiofrequency heat ablation and vertebroplasty in a single session. The aim of performing radiofrequency heat ablation before vertebroplasty in this patient was to destroy tumor tissue and to thrombose the paravertebral and intravertebral venous plexus and thereby minimize procedure-related complications. The purpose of vertebroplasty was to then stabilize the vertebra. Subject and MethodsAn 80-year-old man with suspected renal cell carcinoma and lower back pain was referred to our institutuion. Initial contrast-enhanced multidetector CT (Somatom Volume Zoom; Siemens, Erlangen, Germany) revealed a left renal cell carcinoma and a solitary osteolytic metastasis measuring 3 × 2 cm in the L3 vertebral body (Fig. 1A). Tumor nephrectomy was carried out, but the patient refused the standard treatment options for the vertebral metastasis. Because of the anterior location of the metastasis and the intact posterior cortex of the vertebral body, the decision was made to treat the tumor with percutaneous radiofrequency heat ablation in combination with vertebroplasty. The patient gave written informed consent.We administered general endotracheal anesthesia and placed the patient in a prone position on the CT table. A team of anesthesiologists, trauma surgeons, and radiologists were present in the CT room during the entire procedure. The whole procedure was performed under fluoroscopic and CT guidance. Before radiofrequency heat ablation, a biopsy was taken from the lesion. A small skin incision was made at the puncture site, and an 11-gauge bone marrow biopsy needle (OptiMed, Ettlingen, Germany) was inserted via a transpedicular approach into the tumor. Histopathologic examination confirmed a vertebral metastasis of the renal cell carcinoma. A 16-gauge LeVeen needle electrode (RadioTherapeutics, Sunnyvale, CA) was deployed through the inserted cannula into the central part of the lesion (Fig. 1B). After unsheathing the electrode tines, which opened to a diameter of 2.5 cm in the metastasis, we connected the needle with a rad...

Bone Cement Deposition Patterns with Plasma-Mediated Radio-Frequency Ablation and Cement Augmentation for Advanced Metastatic Spine Lesions

“…20,21 This combination of precision and minimal heat deposition makes it a suitable treatment for these patients with advanced metastases, enabling the creation of a cavity in the anterior portion of the vertebral body (instead of merely displacing tissue as seen in balloon-assisted kyphoplasty) for cement deposition and stabilization. A combined approach to treating these spinal metastases has been described in several publications, 2,22 following the rationale that the tissue cavity allows more control over the injected cement and can help redirect flow away from a compromised posterior cortex or epidural extension and potentially decrease the extent of cement extravasation and posterior displacement of tumors into the spinal canal.…”

Percutaneous vertebroplasty in tumoral osteolysis

“…This is of special interest for stabilizing vertebrae with metastases in the posterior portion of the vertebral body. Recently published studies have shown improvement in vertebral stability and reduced PMMA leakage when tumor ablation was performed prior to PV [41][42][43].…”

Metastatic Spinal Lesions: State-of-the-Art Treatment Options and Future Trends

“…The concept of using the combination of radiofrequency ablation and vertebroplasty caught on quickly as a technically innovative procedure for treating patients with metastatic spinal tumors. Immediately following the report of Grönemeyer et al, 25 several other investigators reported similarly positive clinical outcomes in individual cases 26,27 and in small case series 26,28 using this procedure. The results for a larger multicenter study (N ϭ 43) published in 2004 29 brought to light some of the potential side effects associated with the radio-frequency ablation procedure.…”