Longitudinal Radiographical Changes Following Minimally Invasive Ablation and Cementoplasty of Osteolytic Vertebral Metastases: A Retrospective Study

Abstract

Background: For orthopedic oncology patients who are poor candidates for open spine surgery, minimally invasive radiofrequency ablation and cementoplasty (RFA/C) is becoming increasingly popular for managing osteolytic vertebral metastases. Purpose: We sought to characterize long-term changes in vertebral body radiographical parameters and potential risk of adjacent fractures occurring. Methods: A single-institution, retrospective study of all patients receiving RFA/C for osteolytic thoracic or lumbar vertebral body metastases from 2017 to 2023 was conducted. Vertebral body integrity was assessed by column height changes (anterior, middle, and posterior 1/3), local vertebral angle, and indirect bone mass assessment (at 3, 6, 12, and 24 months postoperatively). The latter was assessed via Hounsfield unit (HU) changes on axial computed tomography. Adjacent vertebral fractures were defined as within 3 vertebral levels above or below index site. Treatment history including radiation therapy was tracked. Results: A total of 54 vertebral levels (26 patients; mean age 59.8 ± 19.0 years; 18 females) were included (mean follow-up 15.8 ± 13.8 months). HU (bone mass proxy) stabilized after RFA/C. Except for middle column height increasing at 3 months, no column height or local angle deformity changes were detected. Adjacent fracture occurred in 4 patients (15.4%); all 4 demonstrated systemic cancer progression. Conclusions: Our findings suggest that RFA/C may provide effective long-term stabilization of the index site that is maintained for at least 1 year postoperatively. All patients who experienced an adjacent fracture occurrence demonstrated radiographic evidence of cancer progression surrounding the treatment sites that appeared unrelated to the procedure itself.

Plain Language Summary

Long-Term X-Ray Changes After Ablation and Cement Stabilization of Cancer Metastases to the Spine: For patients with metastatic cancer to the spine, intensive open surgery may not be a suitable option. The use of radiofrequency ablation and cement injection is becoming more popular for managing the pain and functional limitations imposed by metastatic cancer. This study aimed to examine how the use of ablation and cement affects long-term changes in the spine, including whether there is further loss in the height of each vertebra or changes in the angle of the spine. This study also aims to see if the use of ablation and cement plays a role in causing fractures to surrounding vertebral sites. A total of 54 sites were treated with this procedure across 26 patients. There was no further loss of the vertebral body height and no additional changes to the local spinal angle. Of the 4 patients who experienced fracture in an adjacent vertebral body, all 4 had evidence of systemic cancer progression.