Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty

Abstract

Background: In oncologic patients with metastatic spinal disease, the ideal treatment should be well tolerated, relieve the pain, and preserve or restore the neurological function.The combination of fluoroscopic guided radiofrequency ablation (RFA) and kyphoplasty may fulfill these criteria.

Methods: We describe three pathological vertebral fractures treated with a combination of fluoroscopic guided RFA and kyphoplasty in one session: a 62-year-old man suffering from a painful L4 pathological fracture due to a plasmocytoma, a 68-year-old man with a T12 pathological fracture from metastatic hepatocellular carcinoma, and a 71-year-old man with a Th12 and L1 pathological fracture from multiple myeloma.

Results: The choice of patients was carried out according to the classification of Tomita. Visual analog score (VAS) and Oswestry disability index (ODI) were used for the evaluation of the functional outcomes. The treatment was successful in all patients and no complications were reported. The mean follow-up was 6 months. Marked pain relief and functional restoration was observed.

Conclusion: In our experience the treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty is safe and effective for immediate pain relief in painful spinal lesions in neurologically intact patients.

Figure 1

The two needle approach as shown in the theatre (a) and fluoroscopy (b).

Figure 2

Under fluoroscopic control, the inflation of the balloons is shown.

Figure 3

A 62-year-old man with persistent low back pain. a) The lateral x ray of the lumbar spine shows the collapse of the superior endplate of the L4 vertebral body (arrow). b) The postoperative x ray shows the results of the combined ballon kyphoplasty and radiofrequency ablation, with height restoration.

Figure 4

Malignant fracture of the T12 vertebral body, secondary to hepatocellular carcinoma. α) The sagittal contrast enhanced T1-w TSE MR image shows the malignant fracture with posterior displacement (arrow). An additional secondary deposit is shown in the T11 vertebral body (black arrow). The axial CT images show the preoperative osteolysis (arrow in b) and the postoperative result (c).

Figure 5

Diffuse thoracolumbar pain in a 71-year-old patient. The T1-w TSE MR image (a) and the sagittal reconstruction of the corresponding CT, showed diffuse infiltration of the L1 vertebral body (arrows). In addition, old osteoporotic fractures were noticed in the T12 and L4 vertebrae (open arrows). The bone marrow signal intensity on the MR image is inhomogenous.

Figure 6

The lateral and AP x rays of the lower spine show the postoperative results (case 3). An intravenous cement extravasation from L2 vertebra is shown (arrow).

Figure 7

a) The histopathological examination of the third patient before the radiofrequency shows a large quantity of monoclonal myelomatous cells (×200, H&E). b) The corresponding examination after the ablation shows a significant reduction of the myelomatous cells with diffuse areas of necrosis (×200, H&E).