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Multicenter clinical and imaging evaluation of targeted radiofrequency ablation (t-RFA) and cement augmentation of neoplastic vertebral lesions
  1. Melinda Reyes1,
  2. Mark Georgy2,
  3. Lorenzo Brook3,
  4. Orlando Ortiz4,
  5. Allan Brook5,
  6. Vikas Agarwal6,
  7. Mario Muto7,
  8. Luigi Manfre8,
  9. Stefano Marcia9,
  10. Bassem A Georgy10
  1. 1Point Loma Nazarene University, San Diego, California, USA
  2. 2Department of Family practice and Public Health, University of California, San Diego, La Jolla, California, USA
  3. 3Department of Psychology, Boston University, Boston University, Boston, Massachusetts, USA
  4. 4Department of Radiology, Winthrop-University Hospital, Clinical Professor of Radiology at the State University of New York—Stony Brook, Mineola, New York, USA
  5. 5Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
  6. 6University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  7. 7Cardarelli Hosp Naples Italy, Naples, Italy
  8. 8Department of Neurosurgery -Minimal Invasive Spine, Institute of Oncology in Mediterranean (IOM), Viagrande, Catania, Italy
  9. 9Chief of Radiology Unit, SS Trinità Hospital—ASL Cagliari, Cagliari, Italy
  10. 10San Diego Imaging, University of California, San Diego, San Diego, California, USA
  1. Correspondence to Dr Bassem A Georgy, San Diego Imaging, Associate Professor of Radiology, University of California, San Diego, 5458 Coach Lane, San Diego, CA 92130, USA; bgeorgy{at}


Background Treatment of spinal metastatic lesions by radiofrequency ablation (RFA) before cementation can potentially help in local tumor control and pain relief. This is often limited by access and tumor location. This study reports multicenter clinical and imaging outcomes following targeted RFA (t-RFA) and cement augmentation in neoplastic lesions of the spine.

Material and methods A retrospective multicenter study of 49 patients with 72 painful vertebral lesions, evaluated for clinical and imaging outcomes following RFA and cement augmentation of spinal metastatic lesions, was undertaken. Visual Analogue Pain score (VAS) and Oswestry Disability Index (ODI) were obtained before and 2–4 weeks after treatment. Pre- and post-procedure imaging examinations including MRI and positron emission tomography (PET) were also evaluated.

Results Mean ablation time was 3.7±2.5 min (range 0.92–15). Mean VAS scores decreased from 7.9±2.5 pre-procedure to 3.5±2.6 post-procedure (p<0.0001). Mean ODI scores improved from 34.9±18.3 to 21.6±13.8 post-procedure (p<0.0001). Post-contrast MRI resulted in a predictable pattern of decreased tumor volume and an enhancing rim. Metabolically active lesions in pre-procedure PET scans (n=10 levels) showed decreased fluorodeoxyglucose activity after ablation.

Conclusions t-RFA followed by vertebral augmentation in malignant vertebral lesions resulted in significant pain reduction and functional status improvement, with no major complications. t-RFA permitted access to vertebral lesions and real-time accurate monitoring of the ablation zone temperature. Post-procedure MRI and PET examinations correlated with a favorable tumor response and helped to monitor tumor growth and the timing of adjuvant therapy.

  • Spine
  • Malignant
  • Metastatic

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  • Correction notice Since this paper was first published online data has been updated for accuracy. Data in the pain score management paragraph has also been updated.

  • Contributors All authors have made substantial contributions to the conception or design of the work and the acquisition, analysis, and interpretation of data for the work. All authors helped in drafting the work and revising it critically. All authors worked on the final approval of the submitted version and all authors agree on all aspects of the work to ensure accuracy and integrity of the work.

  • Competing interests BAG is a speaker and consultant for Merit Medical.

  • Ethics approval Ethics approval was obtained from Paloar Health Investigational Review Committee, Escondido, California, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Any additional unpublished data such as unprocessed data, protocols, or images are available from the authors.