Abstract
Introduction
Sacral metastases and myelomatous lesions often result in debilitating pain and significant morbidity in patients with prolonged life expectancy. Radiation therapy and cement augmentation are well described local therapies for controlling cytokine mediated osteolytic bone resportion and skeletal related events associated with metastatic and myelomatous sacral lesions. Ablative therapy has been reported in recent years as a minimally invasive therapy permitting both local treatment of bone lesions and immediate stabilization, when followed with cement augmentation. This case study reports multimodality minimally invasive treatment of patient with multiple painful osteolytic lesions using a novel articulating bipolar RF ablative therapy and an ultrahigh viscosity cement.
Material and Methods
A 75-year-old-patient with history of multiple myeloma and significant lumbar back pain presented with diffuse lytic spinal disease throughout the thoracolumbar and sacral spine. Following review by multidisciplinary tumorboard, percutaneous targeted radiofrequency ablation (t-RFA) was performed in T12-L4 and a unilateral sacral lesion (S1-S3) using an articulated bipolar electrode containing thermocouples to assess real time growth of the ablation zone followed by delivery of ultrahigh viscosity cement using RF energy warmed cement (RF-Targeted Vertebral Augmentation, RF-TVA). Pain was demonstrated preoperatively with 9 using the visual analog scale for both locations. On the first postoperative day pain was at 4(VAS), in the 6 weeks control pain was at 2(VAS). At the 3 months control pain was at 2(VAS).
Results
The combined approach of t-RFA and RF-TVA in the sacrum was technically and clinically feasible with an immediate pain reduction, improvement in quality of life and functionality at 6 weeks and 3 months after the procedure and no complications. CT performed 6 weeks post procedure confirmed the absence of cement leakage.
Conclusion
t-RFA combined with RF-TVA of the sacrum can be safely and effectively performed via a single access port resulting in significant palliative relief and functional improvement. In combination these procedures may provide an alternative palliative, minimally invasive treatment option for painful osteolytic lesions in the sacrum(S1-S3) requiring stabilization for patients in which radiation therapy may not be an option.