Mini-Invasive Treatment of Monolevel Dorsolumbar Metastatic Lesions by Radio Frequency Ablation and Augmentation: Preliminary Experience in a Series of 10 Cases

Abstract

Introduction Technological advances have allowed the development of several “minimally invasive” surgical techniques in the treatment of metastatic spinal tumors. The authors analyzed the effectiveness and impact on quality of life in the short and medium term using radiofrequency ablation and injection of PMMA in the treatment of chronic low back pain in a series of 10 patients suffering from a monolevel metastatic lesion of the dorsolumbar spine. Patients and Methods In 2013, at our Department, 10 patients affected by dorsolumbar monolevel metastatic lesion, in advanced disease, were selected to undergo treatment of transpedicle radio frequency ablation and injection of PMMA. Overall, nine patients were treated by percutaneous technique as they had an already known and suitably treated primary lesion, good performance status, chronic low back pain (mean low back VAS: 8.5), no neurological deficit. Only one patient came to our observation for the presence of low back pain and progressive weakness in the lower limbs, in the absence of already known primitive tumor. In this case, an open surgery with decompression, posterior fusion, and then ablation with augmentation was performed. Results Patients treated percutaneously showed an improvement in pain symptoms with a significant reduction in the VAS (post-op VAS: 3.5) in the absence of new-onset neurological deficit. The patient treated in “open surgery” had a reduction in pain with improvement of neurological function of the lower limbs making it possible walking. All the patients were sent to the oncologist for medical care. Conclusions The radiofrequency thermocoagulation with injection of PMMA seems a good strategy, as palliative treatment, in patients with metastatic advanced disease, with low back pain in the absence of significant neurological deficit when suffering from single level metastatic somatic lesion, ensuring both the effectiveness because of the neoplastic tissue ablation and the augmentation. This allows a gain of QOL in critically ill patients in terms of reduction of pain symptoms.