Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update

Abstract

Spinal metastases are the most commonly encountered tumour of the spine, occurring in up to 40% of patients with cancer. Each year, approximately 5% of cancer patients will develop spinal metastases. This number is expected to increase as the life expectancy of cancer patients increases. Patients with spinal metastases experience severe and frequently debilitating pain, which often decreases their remaining quality of life. With a median survival of less than 1 year, the goals of treatment in spinal metastases are reducing pain, improving or maintaining level of function and providing mechanical stability. Currently, conventional treatment strategies involve a combination of analgesics, bisphosphonates, radiotherapy and/or relatively extensive surgery. Despite these measures, pain management in patients with spinal metastases is often suboptimal. In the last two decades, minimally invasive percutaneous interventional radiology techniques such as vertebral augmentation and radiofrequency ablation (RFA) have shown progressive success in reducing pain and improving function in many patients with symptomatic spinal metastases. Both vertebral augmentation and RFA are increasingly being recognised as excellent alternative to medical and surgical management in carefully selected patients with spinal metastases, namely those with severe refractory pain limiting daily activities and stable pathological vertebral compression fractures. In addition, for more complicated lesions such as spinal metastasis with soft tissue extension, combined treatments such as vertebral augmentation in conjunction with RFA may be helpful. While combined RFA and vertebral augmentation have theoretical benefits, comparative trials have not been performed to establish superiority of combined therapy. We believe that a multidisciplinary approach as well as careful pre-procedure evaluation and imaging will be necessary for effective and safe management of spinal metastases. RFA and vertebral augmentation should be considered during early stages of the disease so as to maintain the remaining quality of life in this patient population group.

Percutaneous Interventional Management of Spinal Metastasis

“…50 This study was challenged for not analyzing the impact of adjunct vertebroplasty (50% of patients received adjunct vertebroplasty) on their conclusion as a potential confounding factor. 51 Combined PVA and MILAP PVA and MILAP independently showed effective pain control in spine metastatic lesions, as discussed earlier. However, the combination of the two techniques demonstrated mixed results, especially in terms of pain control.…”

Therapeutic Intervention in Musculoskeletal Radiology: Current Practice and Future Directions

“…212 Recently, a combination of cementoplasty with ablation was shown to present a viable therapeutic option in certain situations, especially at earlier stages of disease. [213][214][215][216] This may offer both symptomatic pain relief as well structurally stabilizing a lesion. Percutaneous pathologic fracture fixation in combination with cementoplasty was also utilized in clinical practice.…”

Global Approach to the Patient with Pain in Interventional Radiology

“…The most common of these presentations is metastatic disease leading to vertebral body fracture, a scenario for which percutaneous coaxial radiofrequency ablation (RFA) and cementoplasty has recently been shown to be safe and efficacious. [5][6][7][8][9][10] Our approach to a metastatic lesion involving the spine is outlined in ►Fig. 2.…”