Abstract

Haematogenous metastases to the sacrum can produce significant pain and lead to spinal instability. Conventional surgery to palliate pain with acceptable morbidity and mortality has been problematic given the usual short life expectancy of these patients and the high incidence of surgical complications. The Dfine STAR radiofrequency ablation system was recently approved for clinical use for the treatment of pain associated with bony spinal malignancy and other painful benign spinal lesions. In the subgroup of patients with hypervascular metastatic hepatocellular and renal cell cancer to the sacrum without neurological deficits, t-RFA and Sacroplasty using flat panel RCT or CT Fluroscopy in conjunction with electrophysiological monitoring preceeded by transarterial sacral embolisation has proven to be an effective method of pain palliation with extremely low morbidity in the eight patients performed to date. These patients have markedly reduced their requirements for narcotic analgesics and in most instances regained the ability to ambulate previously precluded by pain.