Decision Making: Osteoplasty, Ablation, or Combined Therapy for Spinal Metastases

Abstract

Metastatic disease involving the spine and pelvis is common, often resulting in significant pain and disability. Several percutaneous interventions have been described, including osteoplasty, ablation, and screw fixation, that when used alone or in combination can significantly reduce pain and disability from metastatic bone disease. Although it is possible to make a significant impact in patient care with basic principles and techniques, certain advanced techniques can extend the application of percutaneous interventions while minimizing morbidity.

Keywords

vertebroplasty - ablation - metastases - bone - interventional radiology

• References

• 1 Piccioli A, Spinelli MS, Maccauro G. Impending fracture: a difficult diagnosis. Injury 2014; 45 (Suppl. 06) S138-S141
• 2 Thibault I, Al-Omair A, Masucci GL. , et al. Spine stereotactic body radiotherapy for renal cell cancer spinal metastases: analysis of outcomes and risk of vertebral compression fracture. J Neurosurg Spine 2014; 21 (05) 711-718
• 3 Cunha MVR, Al-Omair A, Atenafu EG. , et al. Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors. Int J Radiat Oncol Biol Phys 2012; 84 (03) e343-e349
• 4 Rose PS, Laufer I, Boland PJ. , et al. Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol 2009; 27 (30) 5075-5079
• 5 Jawad MS, Fahim DK, Gerszten PC. , et al; on behalf of the Elekta Spine Radiosurgery Research Consortium. Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation. J Neurosurg Spine 2016; 24 (06) 928-936
• 6 Sahgal A, Whyne CM, Ma L, Larson DA, Fehlings MG. Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases. Lancet Oncol 2013; 14 (08) e310-e320
• 7 Martin CT, Skolasky RL, Mohamed AS, Kebaish KM. Preliminary results of the effect of prophylactic vertebroplasty on the incidence of proximal junctional complications after posterior spinal fusion to the low thoracic spine. Spine Deform 2013; 1 (02) 132-138
• 8 Prather H, Hunt D, Watson JO, Gilula LA. Conservative care for patients with osteoporotic vertebral compression fractures. Phys Med Rehabil Clin N Am 2007; 18 (03) 577-591 , xi
• 9 Gold DT. The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 1996; 18 (3, Suppl): 185S-189S
• 10 Berenson J, Pflugmacher R, Jarzem P. , et al; Cancer Patient Fracture Evaluation (CAFE) Investigators. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol 2011; 12 (03) 225-235
• 11 Brown DB, Gilula LA, Sehgal M, Shimony JS. Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol 2004; 182 (02) 319-322
• 12 Bilsky MH, Azeem S. The NOMS framework for decision making in metastatic cervical spine tumors. Curr Opin Orthop 2007; 18 (03) 263-269
• 13 Schoenfeld AJ, Le HV, Marjoua Y. , et al. Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS). Spine J 2016; 16 (04) 482-490
• 14 Leithner A, Radl R, Gruber G. , et al. Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J 2008; 17 (11) 1488-1495
• 15 Harrington KD. The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease. J Bone Joint Surg Am 1981; 63 (01) 36-46
• 16 Clark W, Bird P, Gonski P. , et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016; 388 (10052): 1408-1416
• 17 Munk PL, Rashid F, Heran MK. , et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol 2009; 20 (07) 903-911
• 18 Nakatsuka A, Yamakado K, Maeda M. , et al. Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol 2004; 15 (07) 707-712
• 19 Lane MD, Le HBQ, Lee S. , et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skeletal Radiol 2011; 40 (01) 25-32
• 20 Castañeda Rodriguez WR, Callstrom MR. Effective pain palliation and prevention of fracture for axial-loading skeletal metastases using combined cryoablation and cementoplasty. Tech Vasc Interv Radiol 2011; 14 (03) 160-169
• 21 Pusceddu C, Sotgia B, Fele RM, Melis L. Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol 2013; 24 (02) 229-233
• 22 Kastler A, Alnassan H, Aubry S, Kastler B. Microwave thermal ablation of spinal metastatic bone tumors. J Vasc Interv Radiol 2014; 25 (09) 1470-1475
• 23 Pusceddu C, Sotgia B, Fele RM, Ballicu N, Melis L. Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol 2016; 39 (01) 74-80
• 24 Deschamps F, Farouil G, Ternes N. , et al. Thermal ablation techniques: a curative treatment of bone metastases in selected patients?. Eur Radiol 2014; 24 (08) 1971-1980
• 25 Becker S, Hadjipavlou A, Heggeness MH. Ablation of the basivertebral nerve for treatment of back pain: a clinical study. Spine J 2017; 17 (02) 218-223
• 26 Georgy BA, Wong W. Plasma-mediated radiofrequency ablation assisted percutaneous cement injection for treating advanced malignant vertebral compression fractures. AJNR Am J Neuroradiol 2007; 28 (04) 700-705
• 27 Dupuy DE, Hong R, Oliver B, Goldberg SN. Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal. AJR Am J Roentgenol 2000; 175 (05) 1263-1266
• 28 Lubner MG, Brace CL, Hinshaw JL, Lee Jr FT. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21 (8, Suppl): S192-S203
• 29 Tong FC, Cloft HJ, Joseph GJ, Rodts GR, Dion JE. Transoral approach to cervical vertebroplasty for multiple myeloma. AJR Am J Roentgenol 2000; 175 (05) 1322-1324
• 30 Nakatsuka A, Yamakado K, Takaki H. , et al. Percutaneous radiofrequency ablation of painful spinal tumors adjacent to the spinal cord with real-time monitoring of spinal canal temperature: a prospective study. Cardiovasc Intervent Radiol 2009; 32 (01) 70-75
• 31 Deschamps F, Farouil G, de Baere T. Percutaneous ablation of bone tumors. Diagn Interv Imaging 2014; 95 (7-8): 659-663
• 32 Kurup AN, Morris JM, Boon AJ. , et al. Motor evoked potential monitoring during cryoablation of musculoskeletal tumors. J Vasc Interv Radiol 2014; 25 (11) 1657-1664
• 33 Agarawal JP, Swangsilpa T, van der Linden Y, Rades D, Jeremic B, Hoskin PJ. The role of external beam radiotherapy in the management of bone metastases. Clin Oncol (R Coll Radiol) 2006; 18 (10) 747-760
• 34 Tong D, Gillick L, Hendrickson FR. The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group. Cancer 1982; 50 (05) 893-899
• 35 Grieco CA, Simon CJ, Mayo-Smith WW, Dipetrillo TA, Ready NE, Dupuy DE. Image-guided percutaneous thermal ablation for the palliative treatment of chest wall masses. Am J Clin Oncol 2007; 30 (04) 361-367
• 36 Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys 1995; 32 (04) 959-967
• 37 Di Staso M, Gravina GL, Zugaro L. , et al. Treatment of solitary painful osseous metastases with radiotherapy, cryoablation or combined therapy: propensity matching analysis in 175 patients. PLoS One 2015; 10 (06) e0129021
• 38 Di Staso M, Zugaro L, Gravina GL. , et al. A feasibility study of percutaneous radiofrequency ablation followed by radiotherapy in the management of painful osteolytic bone metastases. Eur Radiol 2011; 21 (09) 2004-2010
• 39 Greenwood TJ, Wallace A, Friedman MV, Hillen TJ, Robinson CG, Jennings JW. Combined ablation and radiation therapy of spinal metastases: a novel multimodality treatment approach. Pain Physician 2015; 18 (06) 573-581
• 40 Hussein MA, Vrionis FD, Allison R. , et al; International Myeloma Working Group. The role of vertebral augmentation in multiple myeloma: International Myeloma Working Group Consensus Statement. Leukemia 2008; 22 (08) 1479-1484
• 41 Roedel B, Clarençon F, Touraine S. , et al. Has the percutaneous vertebroplasty a role to prevent progression or local recurrence in spinal metastases of breast cancer?. J Neuroradiol 2015; 42 (04) 222-228
• 42 Erdem E, Samant R, Malak SF. , et al. Vertebral augmentation in the treatment of pathologic compression fractures in 792 patients with multiple myeloma. Leukemia 2013; 27 (12) 2391-2393
• 43 Tutton SM, Pflugmacher R, Davidian M, Beall DP, Facchini FR, Garfin SR. KAST Study: The Kiva system as a vertebral augmentation treatment—a safety and effectiveness trial: a randomized, noninferiority trial comparing the Kiva system with balloon kyphoplasty in treatment of osteoporotic vertebral compression fractures. Spine 2015; 40 (12) 865-875
• 44 Müller DA, Capanna R. The surgical treatment of pelvic bone metastases. Adv Orthop 2015; 2015: 525363
• 45 Kelekis A, Lovblad KO, Mehdizade A. , et al. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results. J Vasc Interv Radiol 2005; 16 (01) 81-88
• 46 Kurup AN, Morris JM, Schmit GD. , et al. Balloon-assisted osteoplasty of periacetabular tumors following percutaneous cryoablation. J Vasc Interv Radiol 2015; 26 (04) 588-594
• 47 Madaelil TP, Wallace AN, Jennings JW. Radiofrequency ablation alone or in combination with cementoplasty for local control and pain palliation of sacral metastases: preliminary results in 11 patients. Skeletal Radiol 2016; 45 (09) 1213-1219
• 48 Cazzato RL, Koch G, Buy X. , et al. Percutaneous image-guided screw fixation of bone lesions in cancer patients: double-centre analysis of outcomes including local evolution of the treated focus. Cardiovasc Intervent Radiol 2016; 39 (10) 1455-1463
• 49 Hartung MP, Tutton SM, Hohenwalter EJ, King DM, Neilson JC. Safety and efficacy of minimally invasive acetabular stabilization for periacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol 2016; 27 (05) 682-688.e1