Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: preliminary results in 12 patients.
OBJECTIVE
To evaluate the safety and clinical benefit of vertebral tumor treatment by combined radiofrequency ablation (RFA) and vertebroplasty, for pain reduction in patients who are unable to benefit from noninvasive treatment methods.


METHODS
Twelve patients with painful vertebral tumors with posterior wall defect, in whom medical treatment together with radiation therapy and/or chemotherapy had failed, were treated with RFA combined with vertebroplasty. Procedures were performed using multislice CT-fluoroscopy and lateral C-arm fluoroscopic guidance. All patients had posterior wall defects of the vertebra being treated. Ten had lytic posterior wall destruction and two had posterior wall fracture. The visual analog scale (VAS) pain score was measured before, one week after, and three months after treatment. VAS patient satisfaction score was measured before and one week after treatment. The VAS score range was 0-20. The analgesic use was evaluated before and four weeks after treatment and complications were monitored.


RESULTS
Combined RFA and vertebroplasty treatment was technically successful in all patients. Pain significantly decreased after treatment: the mean VAS pain score before treatment was 17.33 +/- 2.46 (range, 13-20) versus 9.25 +/- 4.81 (range, 2-18) one week after treatment (P < .001) and was 7.00 +/- 5.26 (range, 1-14) three months after treatment (P = .020). The mean VAS satisfaction score of all patients was 15.83 +/- 4.26 (range, 4-20). Analgesic use decreased after treatment. No serious treatment related complications occurred.


CONCLUSIONS
RFA in combination with vertebroplasty for treating vertebral tumors with posterior wall defect appeared safe, and reduced pain substantially in patients who did not benefit from other noninvasive treatment methods.
van der Linden
Edwin
E
Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. e.van_der-linden@lumc.nl
Kroft
Lucia J M
LJ
Dijkstra
P D Sander
PD
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D001843:Bone Cements / Q000627:therapeutic use*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D004564:Electrocoagulation / Q000009:adverse effects; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000150:complications / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000700:Analgesics; D001843:Bone Cements; D019904:Polymethyl Methacrylate