Skip to main content

Advertisement

SpringerLink
Log in

Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update

  • Neuro-oncology (GJ Lesser, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Spinal metastases are the most commonly encountered tumour of the spine, occurring in up to 40% of patients with cancer. Each year, approximately 5% of cancer patients will develop spinal metastases. This number is expected to increase as the life expectancy of cancer patients increases. Patients with spinal metastases experience severe and frequently debilitating pain, which often decreases their remaining quality of life. With a median survival of less than 1 year, the goals of treatment in spinal metastases are reducing pain, improving or maintaining level of function and providing mechanical stability. Currently, conventional treatment strategies involve a combination of analgesics, bisphosphonates, radiotherapy and/or relatively extensive surgery. Despite these measures, pain management in patients with spinal metastases is often suboptimal. In the last two decades, minimally invasive percutaneous interventional radiology techniques such as vertebral augmentation and radiofrequency ablation (RFA) have shown progressive success in reducing pain and improving function in many patients with symptomatic spinal metastases. Both vertebral augmentation and RFA are increasingly being recognised as excellent alternative to medical and surgical management in carefully selected patients with spinal metastases, namely those with severe refractory pain limiting daily activities and stable pathological vertebral compression fractures. In addition, for more complicated lesions such as spinal metastasis with soft tissue extension, combined treatments such as vertebral augmentation in conjunction with RFA may be helpful. While combined RFA and vertebral augmentation have theoretical benefits, comparative trials have not been performed to establish superiority of combined therapy. We believe that a multidisciplinary approach as well as careful pre-procedure evaluation and imaging will be necessary for effective and safe management of spinal metastases. RFA and vertebral augmentation should be considered during early stages of the disease so as to maintain the remaining quality of life in this patient population group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Klimo P, Schmidt MH. Surgical management of spinal metastases. Oncologist. 2004;9(2):188–96.

    Article  PubMed  Google Scholar 

  2. Kassamali R, Ganeshan A, Hoey E, Crowe P, Douis H, Henderson J. Pain management in spinal metastases: the role of percutaneous vertebral augmentation. Ann Oncol. 2011;22(4):782–6.

    Article  CAS  PubMed  Google Scholar 

  3. Halpin RJ, Bendok BR, Liu JC. Minimally invasive treatments for spinal metastases: vertebroplasty, kyphoplasty, and radiofrequency ablation. J Support Oncol. 2004;2(4):339–51.

    PubMed  Google Scholar 

  4. Georgy BA. Metastatic spinal lesions: state-of-the-art treatment options and future trends. AJNR Am J Neuroradiol. 2008;29(9):1605–11.

    Article  CAS  PubMed  Google Scholar 

  5. Ontario HQ. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review. Ontario Health Technol Assess Series. 2016;16(11):1.

    Google Scholar 

  6. Janjan NA. Radiation for bone metastases. Cancer. 1997;80(S8):1628–45.

    Article  CAS  PubMed  Google Scholar 

  7. Madaelil TP, Wallace AN, Jennings JW. Radiofrequency ablation alone or in combination with cementoplasty for local control and pain palliation of sacral metastases: preliminary results in 11 patients. Skelet Radiol. 2016;45(9):1213–9.

    Article  Google Scholar 

  8. • Wallace A, Tomasian A, Vaswani D, Vyhmeister R, Chang R, Jennings J. Radiographic local control of spinal metastases with percutaneous radiofrequency ablation and vertebral augmentation. Am J Neuroradiol. 2016;37(4):759–65. One of the largest observational studies assessing local tumour control following combined RFA and vertebral augmentation in spinal metastases

    Article  CAS  PubMed  Google Scholar 

  9. Kurup AN, Callstrom MR. Ablation of skeletal metastases: current status. J Vasc Interv Radiol. 2010;21(8, Supplement):S242–S50.

    Article  PubMed  Google Scholar 

  10. Munk PL, Murphy KJ, Gangi A, Liu DM. Fire and ice: percutaneous ablative therapies and cement injection in management of metastatic disease of the spine. Semin Musculoskelet Radiol. 2011;15(2):125–34.

    Article  PubMed  Google Scholar 

  11. Munk PL, Rashid F, Heran MK, Papirny M, Liu DM, Malfair D, et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol. 2009;20(7):903–11.

    Article  PubMed  Google Scholar 

  12. Lane MD, Le HB, Lee S, Young C, Heran MK, Badii M, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skelet Radiol. 2011;40(1):25–32.

    Article  Google Scholar 

  13. Reyes M, Georgy M, Brook L, Ortiz O, Brook A, Agarwal V, et al. Multicenter clinical and imaging evaluation of targeted radiofrequency ablation (t-RFA) and cement augmentation of neoplastic vertebral lesions. J NeuroInterv Surg. 2017; Large clinical study reporting outcomes following combined RFA and cement augmentation from multiple centres

  14. Halpin RJ, Bendok BR, Sato KT, Liu JC, Patel JD, Rosen ST. Combination treatment of vertebral metastases using image-guided percutaneous radiofrequency ablation and vertebroplasty: a case report. Surg Neurol. 2005;63(5):469–74.

    Article  PubMed  Google Scholar 

  15. Grönemeyer DH, Schirp S, Gevargez A. Image-guided radiofrequency ablation of spinal tumors: preliminary experience with an expandable array electrode. Cancer J. 2002;8(1):33–9.

    Article  PubMed  Google Scholar 

  16. Schaefer O, Lohrmann C, Markmiller M, Uhrmeister P, Langer M. Combined treatment of a spinal metastasis with radiofrequency heat ablation and vertebroplasty. Am J Roentgenol. 2003;180(4):1075–7.

    Article  Google Scholar 

  17. Costa L, Major PP. Effect of bisphosphonates on pain and quality of life in patients with bone metastases. Nat Clin Pract Oncol. 2009;6(3):163–74.

    Article  CAS  PubMed  Google Scholar 

  18. Hayashi S, Hoshi H, Iida T. Reirradiation with local-field radiotherapy for painful bone metastases. Radiat Med. 2001;20(5):231–6.

    Google Scholar 

  19. Tong D, Gillick L, Hendrickson FR. The palliation of symptomatic osseous metastases final results of the study by the radiation therapy oncology group. Cancer. 1982;50(5):893–9.

    Article  CAS  PubMed  Google Scholar 

  20. Huisman M, van den Bosch MA, Wijlemans JW, van Vulpen M, van der Linden YM, Verkooijen HM. Effectiveness of reirradiation for painful bone metastases: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2012;84(1):8–14.

    Article  PubMed  Google Scholar 

  21. Callstrom MR, Charboneau JW, Goetz MP, Rubin J, Wong GY, Sloan JA, et al. Painful metastases involving bone: feasibility of percutaneous CT-and US-guided radio-frequency ablation 1. Radiology. 2002;224(1):87–97.

    Article  PubMed  Google Scholar 

  22. de Ruiter GC, Nogarede CO, Wolfs JF, Arts MP. Quality of life after different surgical procedures for the treatment of spinal metastases: results of a single-center prospective case series. Neurosurg Focus. 2017;42(1):E17.

    Article  PubMed  Google Scholar 

  23. Sundaresan N, Rothman A, Manhart K, Kelliher K. Surgery for solitary metastases of the spine: rationale and results of treatment. Spine. 2002;27(16):1802–6.

    Article  PubMed  Google Scholar 

  24. Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, et al. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg Spine. 2003;98(1):21–30.

    Article  Google Scholar 

  25. McGirt MJ, Parker SL, Wolinsky J-P, Witham TF, Bydon A, Gokaslan ZL. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J. 2009;9(6):501–8.

    Article  PubMed  Google Scholar 

  26. Schroeder JE, Ecker E, Skelly AC, Kaplan L. Cement augmentation in spinal tumors: a systematic review comparing vertebroplasty and kyphoplasty. Evidence-Based Spine-Care J. 2011;2(04):35–43.

    Article  Google Scholar 

  27. •• Vogl TJ, Pflugmacher R, Hierholzer J, Stender G, Gounis M, Wakhloo A, et al. Cement directed kyphoplasty reduces cement leakage as compared with vertebroplasty: results of a controlled, randomized trial. Spine. 2013;38(20):1730–6. Randomised controlled trial demonstrating reduced cemented leaking with kyphoplasty compared to vertebroplasty in osteoporotic-related fractures

    Article  PubMed  Google Scholar 

  28. Radiology. ACo. ACR–ASNR–ASSR–SIR–SNIS practice parameter for the performance of vertebral augmentation. https://www.acr.org/~/media/0AB72B20B91D4571A262BE946E889DC3.pdf: ACR Practice Guideline 2012.

  29. Chandra RV, Meyers PM, Hirsch JA, Abruzzo T, Eskey CJ, Hussain MS, et al. Vertebral augmentation: report of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery. J Neurointerv Surg. 2013:neurintsurg-2013-011012.

  30. National Institute of Health and Care Excellence N. Percutaneous vertebroplasty https://www.nice.org.uk/guidance/ipg122003 [updated 31 January 2012.

  31. Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12(3):225–35.

    Article  PubMed  Google Scholar 

  32. Kobayashi T, Arai Y, Takeuchi Y, Nakajima Y, Shioyama Y, Sone M, et al. Phase I/II clinical study of percutaneous vertebroplasty (PVP) as palliation for painful malignant vertebral compression fractures (PMVCF): JIVROSG-0202. Ann Oncol. 2009;20(12):1943–7.

    Article  CAS  PubMed  Google Scholar 

  33. Lee B, Franklin I, Lewis JS, Coombes RC, Leonard R, Gishen P, et al. The efficacy of percutaneous vertebroplasty for vertebral metastases associated with solid malignancies. Eur J Cancer. 2009;45(9):1597–602.

    Article  PubMed  Google Scholar 

  34. Tian Q-H, Sun X-Q, Lu Y-Y, Wang T, Wu C-G, Li M-H, et al. Percutaneous vertebroplasty for palliative treatment of painful osteoblastic spinal metastases: a single-center experience. J Vasc Interv Radiol. 2016;27(9):1420–4.

    Article  PubMed  Google Scholar 

  35. Chen L, Ni R-F, Liu S-Y, Liu Y-Z, Jin Y-H, Zhu X-L, et al. Percutaneous vertebroplasty as a treatment for painful osteoblastic metastatic spinal lesions. J Vasc Interv Radiol. 2011;22(4):525–8.

    Article  CAS  PubMed  Google Scholar 

  36. Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology. 1996;199(1):241–7.

    Article  CAS  PubMed  Google Scholar 

  37. Chew C, Craig L, Edwards R, Moss J, O’Dwyer P. Safety and efficacy of percutaneous vertebroplasty in malignancy: a systematic review. Clin Radiol. 2011;66(1):63–72.

    Article  CAS  PubMed  Google Scholar 

  38. McDonald RJ, Gray LA, Cloft HJ, Thielen KR, Kallmes DF. The effect of operator variability and experience in vertebroplasty outcomes 1. Radiology. 2009;253(2):478–85.

    Article  PubMed  Google Scholar 

  39. Calmels V, Vallee J-N, Rose M, Chiras J. Osteoblastic and mixed spinal metastases: evaluation of the analgesic efficacy of percutaneous vertebroplasty. Am J Neuroradiol. 2007;28(3):570–4.

    CAS  PubMed  Google Scholar 

  40. Tsoumakidou G, Too CW, Koch G, Caudrelier J, Cazzato RL, Garnon J, et al. CIRSE guidelines on percutaneous vertebral augmentation. Cardiovasc Intervent Radiol. 2017;40(3):331–42.

    Article  PubMed  Google Scholar 

  41. Barragán-Campos HM, Vallée J-N, Lo D, Cormier E, Jean B, Rose M, et al. Percutaneous vertebroplasty for spinal metastases: complications. Radiology. 2006;238(1):354–62.

    Article  PubMed  Google Scholar 

  42. Dupuy DE, Hong R, Oliver B, Goldberg SN. Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal. Am J Roentgenol. 2000;175(5):1263–6.

    Article  CAS  Google Scholar 

  43. Anchala PR, Irving WD, Hillen TJ, Friedman MV, Georgy BA, Coldwell DM, et al. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Phys. 2014;17(4):317–27.

    Google Scholar 

  44. Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 2004;22(2):300–6.

    Article  PubMed  Google Scholar 

  45. Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, et al. Percutaneous radiofrequency ablation of painful osseous metastases. Cancer. 2010;116(4):989–97.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Clarençon F, Jean B, Pham H-P, Cormier E, Bensimon G, Rose M, et al. Value of percutaneous radiofrequency ablation with or without percutaneous vertebroplasty for pain relief and functional recovery in painful bone metastases. Skelet Radiol. 2013;42(1):25–36.

    Article  Google Scholar 

  47. Zheng L, Chen Z, Sun M, Zeng H, Zuo D, Hua Y, et al. A preliminary study of the safety and efficacy of radiofrequency ablation with percutaneous kyphoplasty for thoracolumbar vertebral metastatic tumor treatment. Med Sci Monitor: Int Med J Exp Clin Res. 2014;20:556.

    Article  Google Scholar 

  48. Wallace AN, Robinson CG, Meyer J, Tran ND, Gangi A, Callstrom MR, et al. The metastatic spine disease multidisciplinary working group algorithms. Oncologist. 2015;20(10):1205–15.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Toyota N, Naito A, Kakizawa H, Hieda M, Hirai N, Tachikake T, et al. Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience. Cardiovasc Intervent Radiol. 2005;28(5):578–83.

    Article  PubMed  Google Scholar 

  50. Hoffmann RT, Jakobs TF, Trumm C, Weber C, Helmberger TK, Reiser MF. Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease. J Vasc Interv Radiol. 2008;19(3):419–25.

    Article  PubMed  Google Scholar 

  51. Orgera G, Krokidis M, Matteoli M, Varano GM, La Verde G, David V, et al. Percutaneous vertebroplasty for pain management in patients with multiple myeloma: is radiofrequency ablation necessary? Cardiovasc Intervent Radiol. 2014;37(1):203–10.

    Article  PubMed  Google Scholar 

  52. Georgy B. Bone cement deposition patterns with plasma-mediated radio-frequency ablation and cement augmentation for advanced metastatic spine lesions. Am J Neuroradiol. 2009;30(6):1197–202.

    Article  CAS  PubMed  Google Scholar 

  53. Kim YJ, Lee JW, Park KW, Yeom J-S, Jeong HS, Park JM, et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors 1. Radiology. 2009;251(1):250–9.

    Article  PubMed  Google Scholar 

  54. Masala S, Chiocchi M, Taglieri A, Bindi A, Nezzo M, De Vivo D, et al. Combined use of percutaneous cryoablation and vertebroplasty with 3D rotational angiograph in treatment of single vertebral metastasis: comparison with vertebroplasty. Neuroradiology. 2013;55(2):193–200.

    Article  CAS  PubMed  Google Scholar 

  55. Tomasian A, Wallace A, Northrup B, Hillen T, Jennings J. Spine cryoablation: pain palliation and local tumor control for vertebral metastases. Am J Neuroradiol. 2016;37(1):189–95.

    Article  CAS  PubMed  Google Scholar 

  56. Kastler A, Alnassan H, Aubry S, Kastler B. Microwave thermal ablation of spinal metastatic bone tumors. J Vasc Interv Radiol. 2014;25(9):1470–5.

    Article  PubMed  Google Scholar 

  57. Gangi A, Buy X, editors. Percutaneous bone tumor management. Seminars in interventional radiology; 2010: © Thieme Medical Publishers.

  58. van der Linden E, Kroft LJ, Dijkstra PS. Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: preliminary results in 12 patients. J Vasc Interv Radiol. 2007;18(6):741–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Interventional Radiology Service–Department of Radiology, Austin Hospital, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia

    Ning Mao Kam MD, Julian Maingard MBBS, Dinesh Ranatunga FRANZCR, EBIR & Duncan Brooks FRANZCR, CCINR, EBIR

  2. Department of Interventional Radiology–Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Hong Kuan Kok FFRRCSI, FRCR, EBIR

  3. Interventional Neuroradiology Service–Radiology Department, Austin Hospital, Melbourne, Australia

    Julian Maingard MBBS, Duncan Brooks FRANZCR, CCINR, EBIR & Hamed Asadi FRANZCR, CCINR, EBIR

  4. Interventional Neuroradiology Service–Radiology Department, St Vincent’s Hospital, Melbourne, Australia

    Duncan Brooks FRANZCR, CCINR, EBIR

  5. Department of Radiology, Tallaght Hospital, Dublin, Ireland

    William C. Torreggiani FFRRCSI, FRCR

  6. Musculoskeletal Division, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada

    Peter L. Munk FRCPC, FSIR

  7. Interventional Radiology Service–Department of Radiology, Beaumont Hospital, Dublin, Ireland

    Michael J. Lee FFRRCSI, FRCR, EBIR, FSIR

  8. Interventional Neuroradiology Unit–Monash Imaging, Monash Health, Melbourne, Australia

    Ronil V. Chandra FRANZCR, CCINR & Hamed Asadi FRANZCR, CCINR, EBIR

  9. Department of Imaging, Monash University, Melbourne, Australia

    Ronil V. Chandra FRANZCR, CCINR

  10. School of Medicine–Faculty of Health, Deakin University, Waurn Ponds, Geelong, Australia

    Julian Maingard MBBS & Hamed Asadi FRANZCR, CCINR, EBIR

Authors
  1. Ning Mao Kam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julian Maingard MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong Kuan Kok FFRRCSI, FRCR, EBIR
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dinesh Ranatunga FRANZCR, EBIR
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Duncan Brooks FRANZCR, CCINR, EBIR
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William C. Torreggiani FFRRCSI, FRCR
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter L. Munk FRCPC, FSIR
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael J. Lee FFRRCSI, FRCR, EBIR, FSIR
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ronil V. Chandra FRANZCR, CCINR
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hamed Asadi FRANZCR, CCINR, EBIR
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ning Mao Kam MD.

Ethics declarations

Conflict of Interest

Ning Mao Kam, Julian Maingard, Hong Kuan Kok, Dinesh Ranatunga, Duncan Brooks, William C. Torreggiani, Peter L. Munk, Michael J. Lee, Ronil V. Chandra and Hamed Asadi declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Neuro-oncology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kam, N.M., Maingard, J., Kok, H.K. et al. Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update. Curr. Treat. Options in Oncol. 18, 74 (2017). https://doi.org/10.1007/s11864-017-0516-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11864-017-0516-7

Keywords

Search

Navigation