SpineCombination treatment of vertebral metastases using image-guided percutaneous radiofrequency ablation and vertebroplasty: a case report
Introduction
Metastatic cancer is the most common tumor of the spine and is found in ∼10% to 30% of all cancer patients. The lesions are most common in the thoracic and lumbar regions and, in adults, arise from primary breast, lung, prostate, and renal malignancies [11], [17], [31]. Most patients initially present with pain and are subsequently found to have pathologic fractures, particularly if they have osteolytic metastases or tumors such as spinal myeloma. Because of the advanced nature of the disease at the time of presentation, supportive or palliative care is all that can be offered to many of these patients.
Nonoperative treatment includes analgesic medication, radiotherapy, hormone therapy, chemotherapy, and bisphosphonates [23]. Surgical treatment may involve vertebrectomy, reconstruction with a cage or polymethylmethacrylate bone cement, and stabilization with pedicle screws [8]. The long recovery period and morbidity and mortality associated with surgery make a less invasive means of treatment and make palliation attractive for those patients who are not surgical candidates due to age, comorbidities, or multifocal disease [8], [10].
Percutaneous vertebroplasty is a radiologically guided procedure that consists of percutaneous injection of surgical cement into a vertebral body. It can be used in both benign spine disease such as osteoporotic fractures and malignant lesions such as metastases, lymphomas, and plasmacytomas [3], [15], [29]. It provides pain reduction as well as strengthening and stabilization of the bone [1], [8], [15], [29].
Percutaneous image-guided radiofrequency ablation (RFA) uses thermal energy to cause destruction of tumor cells. It has been used to treat a variety of benign and malignant conditions including tumors in the liver, kidney, adrenal gland, lung, breast, and pancreas [10], [12]. In the musculoskeletal system, it has been used to treat osteoid osteomas, chondroblastomas, epithelioid hemangioendotheliomas, chordomas, and spinal metastases [6], [7], [10], [13], [18], [20], [21], [22], [28], [30].
The combination of RFA and vertebroplasty is a novel concept, which has been described recently. Both therapies are thought to complement each other in the treatment of vertebral metastases. We are aware of 5 patients in the literature who have been treated with the combination of RFA and vertebroplasty for spinal metastases [13], [25]. Only 1 patient was successfully treated with the combination of RFA and vertebroplasty in a single session [25]. We report a patient with metastatic lesions at T9 and T12 treated with a combination of percutaneous RFA and vertebroplasty in a single session.
Section snippets
Case report
A 45-year-old female with recently diagnosed metastatic non-small cell lung cancer was referred for consideration of vertebroplasty after having several weeks of excruciating back pain in the thoracic region. The patient was neurologically intact on physical examination. Computed tomography (CT) and magnetic resonance imaging (MRI) scans of the thoracic spine revealed metastatic lesions at the T9 and T12 bodies with mild narrowing of the canal at T12 (Fig. 1). The lesion at T9 was in the right
Discussion
Patients with vertebral metastases often have pathologic fractures and severe pain. Many of these patients are not good surgical candidates and require palliative care. Nonoperative treatment options include analgesics, radiotherapy, hormone therapy, chemotherapy, and bisphosphonates [23]. Radiation therapy is a standard treatment of bony metastases and may be performed in conjunction with vertebroplasty without altering the cement [16]. It has been shown to give partial or complete pain relief
Grant information
No grants are associated with this article.
Disclosure statement
There are no personal or institutional financial interests by the authors in any of the materials listed in this article.
Acknowledgments
The authors thank Stephen L. Ondra, MD, for his critical review of this article and Jessica Kazmier for her assistance with the preparation of this article.
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