SIR 2024
Pain Management/MSK
Jack Lin, B.A.
University of Miami Medical Student
University of Miami
Financial relationships: Full list of relationships is listed on the CME information page.
Chloe E. Issa, B.S.
University of Miami Medical Student
University of Miami
Financial relationships: Full list of relationships is listed on the CME information page.
Kenneth Richardson, MS-4
University of Miami Medical Student
University of Miami
Financial relationships: Full list of relationships is listed on the CME information page.
Hamed Jalaeian, MD, MSc, RPVI (he/him/his)
Assistant Professor Clinical Interventional Radiology
University of Miami Health System
Financial relationships: Full list of relationships is listed on the CME information page.
Jeffrey Leichter, MD
Assistant Professor Clinical Interventional Radiology
The University of Miami, Miller School of Medicine
Disclosure information not submitted.
To compare the efficacy of single vs. multi-level radiofrequency ablation (RF) in combination with kyphoplasty in patients with painful metastatic spinal disease.
Materials and methods:
All patients with painful metastatic spinal disease who underwent kyphoplasty and RF ablation between 03/2019 and 06/2023 were reviewed in a retrospective manner. 74 patients with a median age of 64 years old (range, 31-88) and a M:F ratio of 0.95. The most common primary neoplastic diseases were as follows: multiple myeloma (n=21, 28.4%), breast (n=17, 23.0%), lung (n=9, 12.2%), and prostate (n=7, 9.5%). 44 patients (59.5%) had single level kyphoplasty and 30 patients (40.5%) had multi-level kyphoplasty with RF ablation. 23 patients (31.1%) underwent 2 level kyphoplasty, 3 patients (8.1%) had 3 level kyphoplasty, and 1 patient (1.4%) had 4 level kyphoplasty. Pain relief was evaluated by the VAS and Oswestry Disability Index (ODI), performance status was evaluated by the Karnofsky Performance Status and ECOG score before and within 3-months after the procedure.
Results:
Technical success was achieved in all patients. Kyphoplasty and RF ablation was performed on thoracic vertebrae in 31 patients (41.9%), lumbar in 35 patients (47.3%), and thoracolumbar in 8 patients (10.8%). The median VAS score decreased from 10 (IQR, 8-10) to 2 (IQR, 0-4) (P < 0.001), median ODI score decreased from 69.5 (IQR, 49.3-80) to 20.0 (IQR, 10-33.5) (P < 0.001), the median KPSS increased from 50 (IQR, 40-65) to 75 (IQR, 60-90) (P =0.001) and median ECOG decreased from 3 (IQR, 2-3) to 1 (IQR, 1-2.0) within 3 months after the procedure (P =0.001). Patients with single level kyphoplasty on average had a statistically longer fluoroscopy time (per level). There was no difference in pain, performance, or disability scores among the groups. There were no major complications.
Conclusion:
RFA in conjunction with Kyphoplasty provides similar improvement in pain, performance, and disability scores in patients with single level or multi-level metastatic spine disease.