Abstract
Percutaneous radiofrequency ablation of spinal metastases is an emerging treatment for patients with painful metastatic spine disease. It is typically performed for patients who have not responded to conventional treatments or who have contraindications to radiotherapy. Destruction of the posterior wall of the vertebral body and epidural disease may be considered relative contraindications for radiofrequency ablation. This is due to the difficulty in achieving satisfactory ablation balanced against the risk of neural injury. We describe a case of metastatic melanoma with an expansile lytic metastasis and epidural tumour extension at the L4 vertebral body level resulting in severe central canal stenosis. This was successfully treated with percutaneous radiofrequency ablation and vertebral augmentation. The patient reported significant pain relief post-procedure and follow-up MRI at two months demonstrated local tumour regression, epidural disease resolution and improved spinal canal dimensions. To the best of our knowledge, this is the first report of epidural disease resolution from metastatic melanoma following radiofrequency ablation and emphasises the potential benefits of ablation therapy even in the presence of canal stenosis and epidural metastatic disease.
Highlights
The spine accounts for approximately 70% of all bone metastases [1,2]
We describe a case of metastatic melanoma with an expansile lytic metastasis and epidural tumour extension at the L4 vertebral body level resulting in severe central canal stenosis
To the best of our knowledge, this is the first report of epidural disease resolution from metastatic melanoma following radiofrequency ablation and emphasises the potential benefits of ablation therapy even in the presence of canal stenosis and epidural metastatic disease
Summary
The spine accounts for approximately 70% of all bone metastases [1,2]. Spinal metastases are often symptomatic and may significantly impair patients' quality of life. Metastatic epidural disease extension is generally considered to be a relative contraindication to spinal ablation given its proximity to neural structures. This case describes successful treatment of painful melanoma metastasis in the lumbar spine with reduced tumour volume, resolution of epidural disease and improved canal dimensions [9]. Care was taken to position the ablation probes such that the ablation zone did not extend beyond the posterior margin of the tumour, and a 20-gauge thermocouple was advanced via a transforaminal approach into the anterior epidural space to allow for continuous temperature monitoring to minimise the risk of neural injury during the ablation procedure. There was disease progression elsewhere and the patient died the following month following a pulmonary emboli
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