Open AccessTreatment of Metastatic Spinal Lesions with a Navigational Bipolar Radiofrequency Ablation Device: A Multicenter Retrospective Study
Author(s) -
Praveen R. Anchala,
Winston D Irving,
Travis J. Hillen,
Michael Friedman,
Bassem Georgy,
D M Coldwell,
Nam Tran,
Frank D. Vrionis,
Allan Brook,
Jack W. Jennings
Publication year - 2014
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2014/17/315
Subject(s) - medicine , visual analogue scale , radiofrequency ablation , retrospective cohort study , surgery , ablation , spinal fracture , radiology
Background: Spinal metastatic lesions are a common occurrence among oncology patientsand contribute to significant morbidity. Treatment options have been limited in their effectivenessand scope to this point.Objective: This study aims to report the safety and efficacy of radiofrequency ablation (RFA)of malignant spinal lesions using a novel RFA bipolar tumor ablation system which includes anavigational electrode containing 2 active thermocouples.Study Design: IRB approved multicenter retrospective review of patients receiving RFA as atreatment of metastatic osseous lesions between March 2012 and March 2013.Setting: This study consists of patients from 5 large academic centers.Method: One hundred twenty-eight metastatic lesions were identified in 92 patients whounderwent a total of 96 procedures. Cement augmentation was performed when the vertebralbody was at risk or had a pathological fracture. Visual analogue scale (VAS) scores were obtainedpreoperatively as well as postoperatively at the one week, one month, and 6 month time points.Interval change in the patients’ pain medications was recorded. Postoperative imaging was usedto assess tumor burden at the treated level when available.Results: RFA was technically successful in all of the lesions without complication or thermalinjury. Our study demonstrated significant (P < 0.01) decreases in the VAS scores at oneweek, one month, and 6 months postoperatively. In our largest center, 54% of our patientsexperienced a decrease and 30% had no change in their pain medications postoperatively. Sixtytwo percent of the spinal lesions in this largest institution were located in the posterior vertebralbody. Post-ablation imaging confirmed size of ablation zones consistent with that measured bythe thermocouples.Limitations: The main limitations of this study are the heterogeneous patient population,data set, and potential confounding variable of concurrent cement augmentation.Conclusion: The STAR System is an RFA device that was safely and effectively used in thetreatment of spine metastatic osseous lesions. This new device allows RFA treatment of previouslyuntreatable lesions with resultant reduction in pain that was not controlled by systemic orradiation therapy.Key words: Radiofrquency ablation, pain, osseous metastasis, spine, interventional oncology,oncology, pain management, tumor, vertebral augmentation