Purpose: To evaluate the safety and efficacy of radiofrequency ablation and cement augmentation for the treatment of secondary metastases to the spine.
Materials and Methods: This single-institution retrospective study evaluated the treatment of 332 lesions in 165 patients (94 men, mean age 64 years) over a 2 year period (2017 – 2019). Percutaneous radiofrequency ablation (RFA) and cement augmentation was performed under fluoroscopic or computed tomography guidance; kyphoplasty versus vertebroplasty was performed at the discretion of the provider. Treated levels included upper thoracic (39/332), lower thoracic (121/332), and lumbar (172/332) vertebral bodies.
Results: The majority of treated levels (262/322, 81%) resulted in a substantial improvement in pain ( > 2 point reduction in Brief Pain Inventory scale following the procedure). Based on univariable and multivariable analysis, significant predictors of treatment failure included cancer type (melanoma, hematologic malignancies; P < 0.001), age > 70 years (P = 0.03), and interventional imaging modality (fluoroscopy, P = 0.01). Cement leakage occurred in 19% (61/322) of treated levels, though leakage was asymptomatic in all but 1 patient; posterior vertebral body wall erosion due to tumor was present in 19% (62/322) of treated levels and was not associated with leakage. However, use of RFA was significantly associated with a decreased rate of leakage (P = 0.003). No patients experienced spinal cord or spinal nerve injury following RFA.
Conclusion: Radiofrequency ablation and cement augmentation is a safe and effective treatment for painful spinal metastasis.