SIR 2024
Pain Management/MSK
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.
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.
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.
This study compares outcomes of RFA in combination with kyphoplasty for the treatment of patients with painful metastatic disease to the spine, using articulating (Merit STAR) versus non-articulating (Medtronic Osteocool) RFA systems.
Materials and Methods:
All patients with painful metastatic spinal disease who underwent kyphoplasty and RFA between 03/2019 and 06/2023 were reviewed in a retrospective manner. Of 74 patients, 44 (59.5%) who had kyphoplasty at a single vertebral level only were included in the study. 31 patients (70.5%) had RFA using a non-articulating system (Medtronic Osteocool) and 13 patients (29.5%) had RFA using an articulating arm system (Merit STAR). The mean age was 63.1 yo (SD: 10.4), and M:F ratio 0.76. Most common neoplasms: Multiple myeloma (n=10, 22.7%), breast cancer (n=10, 22.7%), lung (n=5, 11.4%). Pain relief was evaluated by the VAS and ODI score, performance status by KPSS 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 vertebra in 20 patients (45.5%) and lumbar vertebra in 24 patients (54.5%). The median VAS decreased from 10 (IQR, 8-10) to 3 (IQR, 0-4.75) (P < 0.001), median ODI score decreased from 60.0 (IQR, 46-77.5) to 20.0 (IQR, 14.5-33.5) (p=0.001), median KPSS score increased from 50 (IQR, 40-70) to 80 (IQR, 50-90) (P =0.008), and median ECOG score decreased from 3 (IQR, 2-3) to 1 (IQR, 0-2.0) within 3 months after the procedure (P = 0.001). In the subgroup analysis, the radiation exposure and outcome measures were not clinically and statistically different.
Conclusion:
Cement volumes, radiation exposure, pain, performance, and disability scores are not clinically or statistically different with either the articulating or non-articulating RFA system.