Complications of Percutaneous Radiofrequency Ablation of Spinal Osseous Metastases: An 8-Year Single-Center Experience.

Abstract

OBJECTIVE. The purpose of this article was to evaluate the complication rate of percutaneous radiofrequency ablation of spinal osseous metastases. MATERIALS AND METHODS. This retrospective HIPAA-compliant study reviewed complications of radiofrequency ablation combined with vertebral augmentation performed on 266 tumors in 166 consecutive patients for management of vertebral metastases between January 2012 and August 2019. Common Terminology Criteria for Adverse Events (CTCAE) was used to categorize complications as major (grade 3-4) or minor (grade 1-2). Local tumor control rate as well as pain palliation effects evaluated by the Brief Pain Inventory scores determined 1 week, 1 month, 3 months, and 6 months after treatment were documented. Wilcoxon signed rank and Mann-Whitney U tests were used for statistical analysis. RESULTS. Among 266 treated tumors, the total complication rate was 3.0% (8/266), the major complication rate was 0.4% (1/266), and the minor complication rate was 2.6% (7/266). The single major (CTCAE grade 3) periprocedural complication was characterized by lower extremity weakness, difficulty in urination, and lack of erection as a result of spinal cord venous infarct. The seven minor complications included four cases of periprocedural transient radicular pain (CTCAE grade 2) requiring transforaminal steroid injections, one case of delayed secondary vertebral body fracture (CTCAE grade 2) requiring analgesics, and two cases of asymptomatic spinal cord edema on routine follow-up imaging (CTCAE grade 1). The local tumor control rate was 78.9%. There were statistically significant pain palliation effects at all postprocedural time intervals (p < .001 for all). CONCLUSION. Radiofrequency ablation of spinal osseous metastases is safe with a 3.0% rate of complications.