Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases

Radiofrequency ablation (RFA) and vertebral augmentation is an emerging combination therapy for painful osseous metastases that cannot be or are incompletely palliated with radiation therapy. Herein, we report our experience performing RFA and vertebral augmentation of spinal metastases for pain palliation. Institutional review board approval was obtained to retrospectively review our tumor ablation database for all patients who underwent RFA of osseous metastases between April 2012 and July 2014. Patient demographics, lesion characteristics, concurrent palliative therapies, and complications were recorded. Pre- and post-procedure mean worst pain scores 1 and 4 weeks after treatment were measured using the Numeric Rating Scale (10-point scale) and compared. During the study period, 72 RFA treatments of 110 spinal metastases were performed. Eighty one percent (89/110) of metastases involved the posterior vertebral body and 45 % (49/110) involved the pedicles. Vertebral augmentation was performed after 95 % (105/110) of ablations. Mean and median pre-procedure pain scores were 8.0 ± 1.9 and 8.0, respectively. Patients reported clinically significant decreased pain scores at both 1-week (mean, 3.9 ± 3.0; median, 3.25; P < 0.0001) and 4-week (mean, 2.9 ± 3.0; median, 2.75; P < 0.0001) follow-up. No major complications occurred related to RFA and there were no instances of symptomatic cement extravasation. Combination RFA and vertebral augmentation is a safe and effective therapy for palliation of painful spinal metastases, including tumor involving the posterior vertebral body and/or pedicles.