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To compare the clinical efficacy of percutaneous vertebroplasty (PVP) alone and microwave ablation (MWA) combined with PVP for the treatment of painful spinal metastases from non-small cell lung cancer (NSCLC). From October 2014 to October 2021, the data of 58 NSCLC patients with refractory painful spinal metastases (visual analog scale score ≥ 5) were retrospectively collected and analyzed. Patients in Group A ( n  = 30) and Group B ( n  = 28) received PVP alone and MWA combined with PVP, respectively. The primary endpoint was pain relief. The secondary endpoints were quality of life (QoL), local tumor progression (LTP), and complications. The technical success rate was 100% in both groups. Patients in both groups showed similar pain relief at 1–12 weeks, but patients in Group B still showed sustained pain relief at 24 weeks compared to those in Group A ( p  = 0.03). The assessment of QoL showed similar changes. LTP (33.00% vs. 7.14%,  p  = 0.02) and cement leakage rates (40.00% vs. 7.14%,  p  = 0.03) were lower in Group B. The multivariate analysis demonstrated spinal metastases with a maximum diameter ≤ 3.0 cm ( p  = 0.027) and MWA combined with PVP ( p  = 0.028) were two independent protective factors for LTP. For cement leakage, spinal metastases with vertebral body compression ( p  = 0.019) was an independent risk factor, while MWA combined with PVP ( p  = 0.042) was an independent protective factor. MWA combined with PVP for painful spinal metastases from NSCLC performed more sustained pain relief (&gt;6 months) and ultimately improved QoL with lower LTP and cement leakage rates, compared to PVP alone.

PVP with or without microwave ablation for the treatment of painful spinal metastases from NSCLC: a retrospective case-control study