title: [Percutaneous vertebroplasty combined with radiofrequency ablation for a patient with a spinal metastatic tumor: case report].
abstract: Recent technological development has allowed expanding applications of radiofrequency ablation (RFA) for malignant tumor therapy. We report a case with a spinal metastatic tumor treated with combination of percutaneous vertebroplasty (PVP) that provides pain relief and spinal stabilization and RFA. A 68-year-old male who had undergone resection of left ureteric carcinoma was referred to our hospital with lower back pain due to the fifth lumbar (L5) vertebral metastatic tumor. Conventional radiation therapy was discontinued because of pneumonia. One year later, the patient was admitted again with weakness of the right knee and foot and severe pain of the back and the right lower extremity. Radiographs demonstrated a compressive fracture of the L5 vertebra predominantly on the right side. CT and MRI showed a tumor of the L5 body invading the right pedicle, the intervertebral foramen, and the retroperitoneal space. RFA was performed in the ventral part of the L5 body, and then around the right L5/the first sacral intervertebral foramen. Temperature and time for ablation ranged from 74 degrees C to 95 degrees C and from 11 min. to 30 min., respectively. Next, PVP was performed by the right transpedicular approach. Bone cement was injected into the L5 body and the pedicle by an amount of 3.0 ml in total without technical complications. Postoperatively, visual analogue scale demonstrated decreased pain degree from 10 cm to 5.4 cm. Combined treatment with RFA and PVP is a feasible and promising procedure for spinal metastatic tumors. Further evaluation is necessary to confirm its long-term efficacy.
authors.affiliation: Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama-city, Japan. kojitoku@md.okayama-u.ac.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Tokunaga
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugiu
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Miyoshi
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Mimura
authors.forename: Susumu
authors.initials: S
authors.lastname: Kanazawa
authors.forename: Isao
authors.initials: I
authors.lastname: Date
mesh_terms: D000368:Aged; D001416:Back Pain / Q000209:etiology; D001843:Bone Cements; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D006801:Humans; D007278:Injections, Spinal; D008159:Lumbar Vertebrae; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000628:therapy*; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000473:pathology
chemical_list: D001843:Bone Cements