title: Reconstruction of Vertebral Body After Radiofrequency Ablation and Augmentation in Dorsolumbar Metastatic Vertebral Fracture: Analysis of Clinical and Radiological Outcome in a Clinical Series of 18 Patients.
abstract: Painful spinal metastases usually occur in malignant neoplastic disease. Treatment for bone metastases has been largely conservative, and it includes the use of high doses of analgesics, radiotherapy, chemotherapy, hormone therapy, and bisphosphonates; however, results are sometimes transient and ineffective. In the presence of neurological involvement a surgical strategy should be considered. Recently, percutaneous procedures such as radiofrequency ablation, vertebroplasty, and kyphoplasty have been introduced as palliative techniques to treat painful vertebral metastases [3, 11, 25].
  
  
  
  In our study we combined the use of radiofrequency ablation with vertebroplasty in the treatment of dorsolumbar metastatic vertebral fractures in order to examine the relationship between restoration of the vertebral structure and decrease in pain. From January 2014 to March 2015 we retrospectively analyzed 18 patients with malignant vertebral lesions who underwent radiofrequency ablation with vertebroplasty followed by cementoplasty, with posterior transpedicle fixation on levels near the lesions. The parameters examined were: demographics, pain relief, and the distribution of polymethylmethacrylate (PMMA) determined by the mean Saliou filling score; all complications were recorded.
  
  
  
  The mean age of the patients was 55.72 years (range 34-69); average operative time was 60.4 min (range, 51-72). The average pain index score (visual analog score; VAS) decreased significantly from 8.05 at baseline to 3.0 (p < 0.05) after 6 months. The Saliou filling score revealed a distribution of PMMA in the vertebral body that was satisfactory (12-18) in eight patients, mediocre (6-12) in seven patients, and inadequate (0-6) in the remaining three patients. In two vertebrae, minimal asymptomatic cement leakage occurred in the lateral recess without neurological damage. No pulmonary embolism and no visceral or neural damage was recorded.
  
  
  
  Radiofrequency ablation combined with vertebroplasty seems to achieve rapid and lasting improvement in clinical symptoms in patients with malignant vertebral lesions. There was wide diffusion of PMMA in the vertebral body, with a mean cement volume of 4.5 ml.
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Maugeri
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy. franeurosurgery@libero.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Graziano
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Basile
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gulì
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Giugno
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy.
authors.forename: Giuseppe Roberto
authors.initials: GR
authors.lastname: Giammalva
authors.affiliation: Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro 129, Palermo, 90100, Italy.
authors.forename: Domenico Gerardo
authors.initials: DG
authors.lastname: Iacopino
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain; D001943:Breast Neoplasms / Q000473:pathology; D017115:Catheter Ablation / Q000379:methods*; D060826:Cementoplasty / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D010147:Pain Measurement; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology; D016103:Spinal Fractures / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology; D054854:Vertebroplasty / Q000379:methods*
keywords: Minimally invasive spinal surgery; Radiofrequency ablation; Spinal metastases; Vertebral fractures; Vertebroplasty