Introduction Over 1.5M patients are diagnosed annually with cancer in the United States. (Noone) The spine is the most common site of bone metastasis. Over 60% of spinal metastases are symptomatic (Maccauro) and often limit a patient’s ability to cooperate for radiation or chemotherapy. Although radiofrequency (RF) ablation has proven effective in providing palliative relief, the unique anatomy of the spine has resulted in limited adoption of RF ablation of such lesions.
Methods A retrospective analysis was performed of 39 procedures in 27 patients with a wide variety of spinal neoplasms and secondary painful compression fractures which limited their ability to undergo conventional chemotherapy and radiation. Targeted RF ablation (t-RFA) followed by cement augmentation was performed via a minimally invasive coaxial system. An innovative RF ablation system (STAR) consisting of a robust articulating, navigational bipolar electrode containing two active thermocouples (TCs) permitted real time monitoring to determine the size of the ablations. Access and number of ablations were based on lesion size and location, and ability to articulate the bipolar electrode. Cement augmentation via the same guiding cannula was performed once physiologic temperature was confirmed.
Results 39 levels from T4 to S3 were treated successfully with RF ablation and vertebral augmentation without complication. Articulation of the ablation device enabled access to lesions throughout the vertebral bodies. Ablation zones were successfully controlled by monitoring TC temperature in-situ and, when necessary, adjusting power. No thermal injury occurred. Cement augmentation following t-RFA was efficient and resulted in a predictable filling. Pain control was rapidly achieved in all patients allowing them to restart chemotherapy or radiation therapy. One patient required addition RF ablation and vertebral augmentation at adjacent levels as his disease progressed and pain recurred.
Conclusion Our initial clinical experience shows that targeted RF ablation using a novel articulating ablation technology, combined with vertebral augmentation, provides a safe method of stabilisation and pain control allowing patients who otherwise would be unable, to continue with conventional cancer therapy.
Disclosures J. Rutledge: None. K. Conrad: None. M. Parker: None.
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