52 - Morphine Equivalent and Pain Scores Following Kyphoplasty with Radiofrequency Ablation in Patients with Spinal Metastatic Disease

Purpose: To determine the efficacy in pain improvement and of morphine equivalent usage after kyphoplasty with radiofrequency ablation (RFA) in patients with painful metastatic neoplastic disease to spinal vertebrae.

Materials and Methods: All patients with symptomatic metastatic spinal disease who underwent kyphoplasty and RFA between 03/2019 and 07/2024 were reviewed in a retrospective manner. 86 patients with a median age of 63.5 years (range, 31-88) and a M ratio of 1.05 were included. Multiple myeloma (n=22, 26.2%), breast cancer (n=20, 23.8%), lung cancer (n=11, 13.1%), prostate cancer (n=10, 11.9%), lymphoma (n=5, 6%), colorectal cancer (n=3, 4.1%), and renal cell carcinoma (n=2, 2.4%) were the most common primary neoplasms. Morphine equivalent daily dosage (MEDD) and visual analog scale (VAS) pain scores were recorded before the procedure and within 3 month post-procedure. The highest documented VAS scores and MEDD pre- and post-procedure were analyzed.

Results: Technical success was achieved in all patients. Kyphoplasty and RFA were performed on thoracic vertebrae in 35 patients (40.7%), lumbar vertebrae in 41 patients (47.7%), and thoracolumbar vertebrae in 10 patients (11.6%). Forty-nine patients (57%) had kyphoplasty at one vertebral level, 28 patients (32.6%) had two-level kyphoplasty, 6 patients (7%) had three-level kyphoplasty, and 3 patients (3.5%) had a four-level spinal kyphoplasty. The median amount of cement per kyphoplasty level was 3.5 cc (IQR, 2.9-4.5). The median morphine equivalent usage decreased significantly from 40 mg (IQR, 0-62 mg) pre-procedure to 0 mg (IQR, 0.0-45 mg) post-procedure (Z = -3.351, p < 0.001, r = 0.398). The median VAS pain score decreased from 10.0 (IQR, 8.0-10.0) pre-procedure to 2.5 (IQR, 0-4.25) within 3 months post-procedure (p < 0.001). There were no major complications reported.

Conclusion: Kyphoplasty with RFA is safe and provides meaningful clinical improvement in reducing both morphine equivalent usage and pain scores in patients with painful metastatic disease to the spine when measured at post-procedure follow-up within 3 months.