SIR 2024
Pain Management/MSK
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.
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.
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 determine the efficacy in pain improvement and the safety of radiofrequency ablation in conjunction with kyphoplasty in the treatment of patients with painful metastatic neoplastic disease to spine vertebrae.
Materials and methods:
All patients with symptomatic 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 (range, 31-88) and a M:F ratio of 0.95. Multiple myeloma (n=21, 28.4%), breast cancer (n=17, 23.0%), lung cancer (n=9, 12.2%), prostate cancer (n=7, 9.5%), lymphoma (n=4, 5.4%), colorectal cancer (n=3, 4.1%), and renal cell carcinoma (n= 2, 2.7%). Twenty-four patients (32.4%) also received adjunctive external beam radiation therapy before or after Kyphoplasty ablation. Pain relief was evaluated by VAS and Oswestry Disability Index (ODI) score, while patient performance status was evaluated by the Karnofsky Performance Status Scale (KPSS) score and ECOG score before and within 3-months after the procedure. The highest documented VAS, ODI, KPSS, and ECOG scores pre and post-procedure were recorded.
Results:
Technical success was achieved in all patients. Kyphoplasty and RF ablation was performed on thoracic vertebrae in 31 patients (41.9%), lumbar vertebrae in 35 patients (47.3%), and thoracolumbar vertebrae in 8 patients (10.8%). 44 patients (59. 5%) had kyphoplasty at one vertebral level, 23 patients (31.1%) had two-level kyphoplasty, 6 patients (8.1%) had three-level kyphoplasty, and one patient (1.4%) had a four-level spinal kyphoplasty. Median amount of cement per kyphoplasty level was 3.2 cc (IQR, 2.5-4.4). The median VAS score decreased from 10 (IQR, 8-10) to 2 (IQR, 0-4) at 3 months after the procedure (median change -6 (IQR, -9 to -4), P < 0.001). The median ODI score decreased from 69.5 (IQR, 49.3-80) to 20.0 (IQR, 10-33.5) at 3 months after the procedure (median change -27 (IQR, -51 to -12.5), P < 0.001). The median KPSS score increased from 50 (IQR, 40-65) to 75 (IQR, 60-90) at 3 months after the procedure (median change 17.5 (IQR, 10 to 30), P =0.001). The median ECOG score decreased from 3 (IQR, 2-3) to 1 (IQR, 1-2.0) at 3 months after the procedure (median change -1.0 (IQR, -2.0 to 0), P =0.001). There were no major complications. There was no change in the neurologic status from the baseline exam.
Conclusion:
RFA with Kyphoplasty appears to be safe and provides a meaningful clinical improvement in VAS, ODI, KPSS, and ECOG scores in patients with painful metastatic disease to the spine, when measured at post-procedure follow-up within 3 months of the procedure.