Radiofrequency-Targeted Vertebral Augmentation for the Treatment of Vertebral Compression Fractures as a Result of Multiple Myeloma

Abstract

A retrospective review of a consecutive population of patients treated with radiofrequency-targeted vertebral augmentation (RF-TVA) for malignant vertebral compression fractures (VCFs). To investigate the safety and efficacy of RF-TVA in patients with malignant VCFs. The use of polymethylmethacrylate (PMMA) in vertebroplasty and balloon kyphoplasty for patients with recalcitrant pain after acute VCFs is shown to be safe, successful in stabilizing the VCF, and effective for the relief of pain after osteoporotic and malignant VCFs. RF-TVA using targeted cavity creation and ultrahigh viscosity PMMA delivery with a long handling time was developed to address the potential adverse issues that arise with vertebroplasty and balloon kyphoplasty. Between December 2008 and May 2009, a consecutive series of 66 RF-TVA procedures were performed by the authors for VCF secondary to multiple myeloma. Pre- and postoperatively, a standard 10-point visual analogue scale was used to assess back pain. Pain medication use and activity categories were defined and monitored for changes before and after RF-TVA. All patients were followed for 6 months postoperatively. At 6 months postoperatively, significant improvement in pain, activity, and narcotic use was observed. There were no pulmonary or neurological complications, and one patient had radiographical evidence of asymptomatic leakage of PMMA into the vertebral disc space. We report optimum safety and efficacy results in the treatment of malignant VCFs with a novel RF-TVA technique in which controlled delivery of an ultrahigh viscosity PMMA is used for fracture stabilization. The deposition of PMMA with RF-TVA is predictable and uniform, and can be performed without the PMMA handling constraints that may be encountered with vertebroplasty and balloon kyphoplasty. The safety and efficacy we report with RF-TVA achieved equivalency with other methods of treatment for VCF stabilization.