Treatment of Vertebral Tumor with Posterior Wall Defect Using Image-guided Radiofrequency Ablation Combined with Vertebroplasty: Preliminary Results in 12 Patients

Linden, E. van der; Kroft, Lucia J.M.; Dijkstra, P.D. Sander

doi:10.1016/j.jvir.2007.02.018

Cited by 63 publications

(42 citation statements)

References 17 publications

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“…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.…”

Section: Radio-frequency Ablation With Vertebroplastymentioning

confidence: 74%

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

Georgy¹

2008

AJNR Am J Neuroradiol

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SUMMARY:The purpose of this article is to review the current state of the art for treating symptomatic spinal fractures associated with malignant lesions and to present potential future trends in treatments for this patient population. Epidemiology, clinical presentation, and biomechanical ramifications of these lesions are summarized and treatment regimes, clinical outcomes, and complications and technical issues associated with treatments are presented. Potential future trends and new technologies for performing vertebral body augmentation in patients with metastatic spinal lesions are also discussed. Metastatic bone tumors in the spine are painful and debilitating but are challenging to treat and often require relatively extensive surgery, which many clinicians and patients are reluctant to pursue. Percutaneous approaches for performing vertebral body augmentation for treating metastatic spinal lesions have been developed as good alternatives to open surgery. These types of procedures have evolved immensely over the last 10 years, and the current state of the art has been found to fit neatly into the conventional oncologic treatment algorithm. Epidemiology and Clinical PresentationSpinal metastasis is the most commonly encountered tumor of the spine, 1 occurring in Յ40% of patients with cancer. 2 Each year, 5% of patients with cancer, or approximately 61,000 persons, will develop spinal metastasis. 3 The cancers most often metastasizing to the spine include breast (21%), lung (14%), prostate (8%), renal (5%), gastrointestinal (5%), and thyroid (3%). Two of 3 patients are affected in the thoracic spine, whereas affected areas of the other third of patients are split 1:2 in the cervical and lumbar regions, respectively.2 The posterior half of the vertebral body is usually infiltrated first, with the anterior body, lamina, and pedicles becoming involved later. 4 The treatment regimen for spinal metastasis is generally palliative and consists of a combination of medical therapy (steroids, pain medication, and chemotherapy), radiation therapy, and surgery.The primary goals of treatment are to relieve pain and preserve or restore function when managing patients affected by spinal metastasis. Patients with metastatic spine disease typically present with progressive and unrelenting pain that is not alleviated with rest and is often worse at night. Pain is generally described in at least 1 of 3 ways: 1) constant and localized, 2) radicular, or 3) axial, coinciding with functional disability. Localized pain is generally thought to be a result of periosteal stretch occurring with tumor expansion and is usually treated by using radiation because this therapy is effective in decreasing the tumor size. Radicular pain, most likely due to the tumor pressing against the nerve root, is also addressed by using radiation therapy but can be treated by using nerve root blocks as well. Axial pain, most frequently associated with mechanical instability of the spine or pathologic vertebral body fracture, is worsened with physical act...

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Section: Radio-frequency Ablation With Vertebroplastymentioning

confidence: 74%

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

Georgy¹

2008

AJNR Am J Neuroradiol

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“…The most widely used and clinically validated method is radiofrequency ablation. Nevertheless, in patients in whom posterior wall destruction and/or epidural tumor extension is present, the cord may become more vulnerable to thermal nerve damage (34)(35)(36). One series reported cement leakage in seven of 12 metastatic cancer patients with posterior vertebral wall defects following combined radiofrequency ablation (RFA) and vertebroplasty, although no neurological sequelae were noted (34).…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, in patients in whom posterior wall destruction and/or epidural tumor extension is present, the cord may become more vulnerable to thermal nerve damage (34)(35)(36). One series reported cement leakage in seven of 12 metastatic cancer patients with posterior vertebral wall defects following combined radiofrequency ablation (RFA) and vertebroplasty, although no neurological sequelae were noted (34). In another series, four of 15 patients who underwent the same procedure for metastatic vertebral compression fractures developed symptomatic neural damage; three patients with tumor involvement of the posterior cortex developed incomplete hemiplegia, and one with tumor extension to the pedicle developed chronic radiculopathy (35).…”

Section: Discussionmentioning

confidence: 99%

Coblation for metastatic vertebral disease

Prologo

Buethe

Mortell

et al. 2013

Diagn Interv Radiol

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PURPOSEPlasma-mediated radiofrequency ablation (coblation) creates a cavity for directed polymethylmethacrylate deposition through molecular dissociation, providing a safe and efficacious cementoplasty for patients with high-risk, painful vertebral body metastatic disease. The purpose of this study was to retrospectively review and report details regarding the feasibility, safety, and efficacy of coblation and cementoplasty for treating painful advanced vertebral body metastatic disease. MATERIALS AND METHODSFifteen patients with painful metastatic vertebral body fractures with a posterior cortical defect and/or epidural tumor extension underwent percutaneous coblation and cementoplasty. Each patient's medical record was reviewed for technical success, imaging outcome, complications, and palliative effect. RESULTSOf the 15 cases, 14 were completed successfully. Postprocedure imaging studies demonstrated adequate cement deposition within the targeted vertebral body without cement extravasation or fracture progression during the 1-3 months follow-up period. Pain relief was achieved in all patients, and no neurological damage was reported (mean follow-up, 141.1±132.5 days). CONCLUSIONPercutaneous image-guided coblation-mediated cavity creation prior to vertebroplasty allows for safe, efficacious cement deposition in patients with metastatic foci. Future studies prospectively comparing this procedure with other standard-of-care regimens are warranted.

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“…Combined RFA and PVP/cementoplasty for spinal osseous metastasis was first reported in 2002 (5), where subsequent delayed vertebroplasty was performed 3-7 days after RFA. Since then, several clinical trials combining RFA and PVP/cementoplasty have been reported (4,(6)(7)(8)(9). Although only a few reports exist, all of them reported a one hundred percent rate of technical success, as well as significant (80-100%) and immediate pain relief.…”

Section: Discussionmentioning

confidence: 99%

“…The mean duration of pain relief was 7.3 months in one study (6). By combining these two methods, complementary effects in treating metastatic bone lesions can be expected from the tumor necrosis effect of RFA, stabilization effect of PVP/cementoplasty, and additive pain relief effects from both methods (4,6,8,9).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Spinal Osseous Metastasis with Combined Percutaneous Radiofrequency Ablation and Vertebroplasty

Huh

Hong

Kim

et al. 2011

J Korean Soc Radiol

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Metastatic bone lesions are frequently found in cancer patients. Unfortunately, conventional treatments including radiotherapy as the treatment of choice, fail to alleviate pain in 20-30% of patients (1). Recently, percutaneous image-guided treatments were introduced for the treatment of benign and malignant bone tumors (1). The synergistic and additive effects of combined radiofrequency ablation (RFA) and percutaneous vertebroplasty (PVP)/cementoplasty have only been published in a few reports. We present 3 patients with metastatic bone lesions experiencing intractable pain treated with percutaneous RFA and PVP/cementoplasty with encouraging results. Case Reports Case 1A 59-year-old man diagnosed with hepatocelluar carcinoma (HCC) and treated by multiple transarterial chemoembolizations (TACE) developed lower back pain in December 2005. An osteolytic lesion in the L3 vertebral body which was not present on the initial computed tomography (CT) scan was detected. Magnetic resonance (MR) scan of the lumbar spine showed a 2.7 cm sized enhancing mass lesion involving the right L3 body showing T1 low and T2 high signal intensity (Figs. 1A-C). Cortical breakage of the adjacent lower endplate was combined. On February 2006, combined percutaneous radiofrequency ablation (RFA) and PVP was performed under local anesthesia. Intramuscular pethidine (Pethidine HCL 25 mg; Jeil Pharm, Daegu, Korea) and local lidocaine (Lidocaine HCL 400 mg; Huons Co. Ltd., Gyeonggi-do, Korea) was administered and the patient was placed in Recent introduction of image-guided percutaneous methods to treat unresectable bone tumors including metastases that do not respond to conventional radiotherapy or chemotherapy has proven to be effective. Here we present three successfully treated cases of metastatic bone lesions: two cases of malignant bone metastases in the lumbar spine and one in the sacral bone, using combined percutaneous radiofrequency ablation and percutaneous vertebroplasty/cementoplasty. A brief review of literature is also included.

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Treatment of Vertebral Tumor with Posterior Wall Defect Using Image-guided Radiofrequency Ablation Combined with Vertebroplasty: Preliminary Results in 12 Patients

Cited by 63 publications

References 17 publications

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

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

Coblation for metastatic vertebral disease

Treatment of Spinal Osseous Metastasis with Combined Percutaneous Radiofrequency Ablation and Vertebroplasty

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