Avoiding Complications in Bone and Soft Tissue Ablation


As with percutaneous ablation of tumors in the liver, lungs, and kidneys, ablation of bone and non-visceral soft tissue tumors carries risk, primarily from collateral damage to vital structures in proximity to the target tumor. Certain risks are of particular interest when ablating bone and non-visceral soft tissue tumors, namely neural or skin injury, bowel injury, fracture, and gas embolism from damaged applicators. Ablation of large volume tumors also carries special risk. Many techniques may be employed by the interventional radiologist to minimize complications when treating tumors in the musculoskeletal system. These methods include those to depict, displace, or monitor critical structures. Thus, measures to provide thermoprotection may be active, such as careful ablation applicator placement and use of various displacement techniques, as well as passive, including employment of direct temperature, radiographic, or neurophysiologic monitoring techniques. Cementoplasty should be considered in certain skeletal locations at risk of fracture. Patients treated with large volume tumors should be monitored for renal dysfunction and properly hydrated. Finally, ablation applicators should be cautiously placed in the constrained environment of intact bone.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13


  1. 1.

    Adachi A, Kaminou T, Ogawa T, et al. Heat distribution in the spinal canal during radiofrequency ablation for vertebral lesions: study in swine. Radiology. 2008;247(2):374–80.

    PubMed  Article  Google Scholar 

  2. 2.

    Ahrar K, Stafford RJ. Magnetic resonance imaging-guided laser ablation of bone tumors. Tech Vasc Interv Radiol. 2011;14(3):177–82.

    PubMed  Article  Google Scholar 

  3. 3.

    Anchala PR, Irving WD, Hillen TJ, et al. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Physician. 2014;17(4):317–27.

    PubMed  Google Scholar 

  4. 4.

    Beland MD, Dupuy DE, Mayo-Smith WW. Percutaneous cryoablation of symptomatic extraabdominal metastatic disease: preliminary results. AJR Am J Roentgenol. 2005;184(3):926–30.

    PubMed  Article  Google Scholar 

  5. 5.

    Buy X, Basile A, Bierry G, Cupelli J, Gangi A. Saline-infused bipolar radiofrequency ablation of high-risk spinal and paraspinal neoplasms. AJR Am J Roentgenol. 2006;186(5 Suppl):S322–6.

    PubMed  Article  Google Scholar 

  6. 6.

    Buy X, Tok CH, Szwarc D, Bierry G, Gangi A. Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring. Cardiovasc Intervent Radiol. 2009;32(3):529–34.

    PubMed  Article  Google Scholar 

  7. 7.

    Callstrom MR, Atwell TD, Charboneau JW, et al. Painful metastases involving bone: percutaneous image-guided cryoablation–prospective trial interim analysis. Radiology. 2006;241(2):572–80.

    PubMed  Article  Google Scholar 

  8. 8.

    Callstrom MR, Dupuy DE, Solomon SB, et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer. 2013;119(5):1033–41.

    PubMed  Article  Google Scholar 

  9. 9.

    Chosy SG, Nakada SY, Lee FT Jr, Warner TF. Monitoring renal cryosurgery: predictors of tissue necrosis in swine. J Urol. 1998;159(4):1370–4.

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Coskun DJ, Gilchrist J, Dupuy D. Lumbosacral radiculopathy following radiofrequency ablation therapy. Muscle Nerve. 2003;28(6):754–6.

    PubMed  Article  Google Scholar 

  11. 11.

    Deschamps F, Farouil G, Hakime A, et al. Cementoplasty of metastases of the proximal femur: is it a safe palliative option? J Vasc Interv Radiol. 2012;23(10):1311–6.

    PubMed  Article  Google Scholar 

  12. 12.

    Deschamps F, Farouil G, Hakime A, Teriitehau C, Barah A, de Baere T. Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol. 2012;35(6):1428–32.

    PubMed  Article  Google Scholar 

  13. 13.

    Diehn FE, Neeman Z, Hvizda JL, Wood BJ. Remote thermometry to avoid complications in radiofrequency ablation. J Vasc Interv Radiol. 2003;14(12):1569–76.

    PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Dupuy DE, Liu D, Hartfeil D, et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 2010;116(4):989–97.

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Friedman MV, Hillen TJ, Wessell DE, Hildebolt CF, Jennings JW. Hip chondrolysis and femoral head osteonecrosis: a complication of periacetabular cryoablation. J Vasc Interv Radiol. 2014;25(10):1580–8.

    PubMed  Article  Google Scholar 

  16. 16.

    Gangi A, Tsoumakidou G, Buy X, Quoix E. Quality improvement guidelines for bone tumour management. Cardiovasc Intervent Radiol. 2010;33(4):706–13.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Gillams AR, Lees WR. CT mapping of the distribution of saline during radiofrequency ablation with perfusion electrodes. Cardiovasc Intervent Radiol. 2005;28(4):476–80.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Glaiberman CB, Brown DB. Reversible neuropathy caused by overuse following radiofrequency ablation of metastatic pelvic lesions. J Vasc Interv Radiol. 2004;15(11):1307–10.

    PubMed  Article  Google Scholar 

  19. 19.

    Goetz MP, Callstrom MR, Charboneau JW, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 2004;22(2):300–6.

    PubMed  Article  Google Scholar 

  20. 20.

    Hidalgo JA, Reddy CG, Schmit GD, Spinner RJ. Sciatic neuropathy after extruded cement from cementoplasty. Spine J. 2012;12(6):532–3.

    PubMed  Article  Google Scholar 

  21. 21.

    Hillen TJ, Anchala P, Friedman MV, Jennings JW. Treatment of metastatic posterior vertebral body osseous tumors by using a targeted bipolar radiofrequency ablation device: technical note. Radiology. 2014;273(1):261–7.

    PubMed  Article  Google Scholar 

  22. 22.

    Jia J, Pollock M. The pathogenesis of non-freezing cold nerve injury. Observations in the rat. Brain. 1997;120(Pt 4):631–46.

    PubMed  Google Scholar 

  23. 23.

    Kashima M, Yamakado K, Takaki H, et al. Radiofrequency ablation for the treatment of bone metastases from hepatocellular carcinoma. AJR Am J Roentgenol. 2010;194(2):536–41.

    PubMed  Article  Google Scholar 

  24. 24.

    Kelekis A, Lovblad KO, Mehdizade A, et al. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results. J Vasc Interv Radiol. 2005;16(1):81–8.

    PubMed  Article  Google Scholar 

  25. 25.

    Kelekis A, Filippiadis D, Anselmetti G, et al. Percutaneous augmented peripheral osteoplasty in long bones of oncologic patients for pain reduction and prevention of impeding pathologic fracture: the rebar concept. Cardiovasc Intervent Radiol. 2016;39(1):90–6.

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Kojima H, Tanigawa N, Kariya S, Komemushi A, Shomura Y, Sawada S. Clinical assessment of percutaneous radiofrequency ablation for painful metastatic bone tumors. Cardiovasc Intervent Radiol. 2006;29(6):1022–6.

    PubMed  Article  Google Scholar 

  27. 27.

    Kurup AN, Morris JM, Schmit GD, et al. Neuroanatomic considerations in percutaneous tumor ablation. Radiographics. 2013;33(4):1195–215.

    PubMed  Article  Google Scholar 

  28. 28.

    Kurup AN, Morris JM, Boon AJ, et al. Motor evoked potential monitoring during cryoablation of musculoskeletal tumors. J Vasc Interv Radiol. 2014;25(11):1657–64.

    PubMed  Article  Google Scholar 

  29. 29.

    Kurup AN, Morris JM, Schmit GD, et al. Balloon-assisted osteoplasty of periacetabular tumors following percutaneous cryoablation. J Vasc Interv Radiol. 2015;26(4):588–94.

    PubMed  Article  Google Scholar 

  30. 30.

    Lane MD, Le HB, Lee S, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skeletal Radiol. 2011;40(1):25–32.

    PubMed  Article  Google Scholar 

  31. 31.

    Lee FT Jr, Chosy SG, Littrup PJ, Warner TF, Kuhlman JE, Mahvi DM. CT-monitored percutaneous cryoablation in a pig liver model: pilot study. Radiology. 1999;211(3):687–92.

    PubMed  Article  Google Scholar 

  32. 32.

    Lee J, Rhim H, Jeon YH, et al. Radiofrequency ablation of liver adjacent to body of gallbladder: histopathologic changes of gallbladder wall in a pig model. AJR Am J Roentgenol. 2008;190(2):418–25.

    PubMed  Article  Google Scholar 

  33. 33.

    Lessard AM, Gilchrist J, Schaefer L, Dupuy DE. Palliation of recurrent Ewing sarcoma of the pelvis with cryoablation and somatosensory-evoked potentials. J Pediatr Hematol Oncol. 2009;31(1):18–21.

    PubMed  Article  Google Scholar 

  34. 34.

    Masala S, Guglielmi G, Petrella MC, et al. Percutaneous ablative treatment of metastatic bone tumours: visual analogue scale scores in a short-term series. Singapore Med J. 2011;52(3):182–9.

    CAS  PubMed  Google Scholar 

  35. 35.

    Munk PL, Rashid F, Heran MK, et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol. 2009;20(7):903–11.

    PubMed  Article  Google Scholar 

  36. 36.

    Nakatsuka A, Yamakado K, Maeda M, et al. Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol. 2004;15(7):707–12.

    PubMed  Article  Google Scholar 

  37. 37.

    Nakatsuka A, Yamakado K, Takaki H, et al. Percutaneous radiofrequency ablation of painful spinal tumors adjacent to the spinal cord with real-time monitoring of spinal canal temperature: a prospective study. Cardiovasc Intervent Radiol. 2009;32(1):70–5.

    PubMed  Article  Google Scholar 

  38. 38.

    Napoli A, et al. MR Imaging-guided focused ultrasound for treatment of bone metastasis. Radiographics. 2013;33(6):1555–68.

    PubMed  Article  Google Scholar 

  39. 39.

    Nour SG, Aschoff AJ, Mitchell IC, Emancipator SN, Duerk JL, Lewin JS. MR imaging-guided radio-frequency thermal ablation of the lumbar vertebrae in porcine models. Radiology. 2002;224(2):452–62.

    PubMed  Article  Google Scholar 

  40. 40.

    Philip A, Gupta S, Ahrar K, Tam AL. A spectrum of nerve injury after thermal ablation: a report of four cases and review of the literature. Cardiovasc Intervent Radiol. 2013;36(5):1427–35.

    PubMed  Article  Google Scholar 

  41. 41.

    Prologo JD, Passalacqua M, Patel I, Bohnert N, Corn DJ. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience. Skeletal Radiol. 2014;43(11):1551–9.

    PubMed  Article  Google Scholar 

  42. 42.

    Prologo JD, Patel I, Buethe J. Bohnert N Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist. J Vasc Interv Radiol. 2014;25(5):769–75.

    PubMed  Article  Google Scholar 

  43. 43.

    Pusceddu C, Sotgia B, Fele RM, Melis L. Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol. 2013;24(2):229–33.

    PubMed  Article  Google Scholar 

  44. 44.

    Rutkove SB. Effects of temperature on neuromuscular electrophysiology. Muscle Nerve. 2001;24(7):867–82.

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Sabharwal T, Katsanos K, Buy X, Gangi A. Image-guided ablation therapy of bone tumors. Semin Ultrasound CT MR. 2009;30(2):78–90.

    PubMed  Article  Google Scholar 

  46. 46.

    Saliken JC, McKinnon JG, Gray R. CT for monitoring cryotherapy. AJR Am J Roentgenol. 1996;166(4):853–5.

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Sandomirsky M, Crifasi JA, Long C, Mitchell EK. Case report of fatal complication in prostatic cryotherapy. First reported death due to argon gas emboli. Am J Med Pathol. 2012;33(1):68–72.

    Article  Google Scholar 

  48. 48.

    Tomasian A, Wallace A, Northrup B, Hillen TJ, Jennings JW. Spine cryoablation: pain palliation and local tumor control for vertebral metastases. AJNR Am J Neuroradiol. 2016;37(1):189–95.

    CAS  PubMed  Article  Google Scholar 

  49. 49.

    Toyota N, Naito A, Kakizawa H, et al. Radiofrequency ablation therapy combined with cementoplasty for painful bone metastases: initial experience. Cardiovasc Intervent Radiol. 2005;28(5):578–83.

    PubMed  Article  Google Scholar 

  50. 50.

    Tsoumakidou G, Garnon J, Ramamurthy N, Buy X, Gangi A. Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation. Cardiovasc Intervent Radiol. 2013;36(6):1624–8.

    PubMed  Article  Google Scholar 

  51. 51.

    Tsoumakidou G, Borensztein M, Zini C, Garnon J, Gangi A. Postablation insufficiency fracture of the iliac crest: management by percutaneous screw fixation. Cardiovasc Intervent Radiol. 2014;37(4):1126–8.

    PubMed  Article  Google Scholar 

  52. 52.

    Tuncali K, Morrison PR, Winalski CS, et al. MRI-guided percutaneous cryotherapy for soft-tissue and bone metastases: initial experience. AJR Am J Roentgenol. 2007;189(1):232–9.

    PubMed  Article  Google Scholar 

  53. 53.

    Uri IF, Garnon J, Tsoumakidou G, Gangi A. An ice block: a novel technique of successful prevention of cement leakage using an ice ball. Cardiovasc Intervent Radiol. 2015;38(2):470–4.

    PubMed  Article  Google Scholar 

  54. 54.

    Weill A, Kobaiter H, Chiras J. Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement. Eur Radiol. 1998;8(1):123–9.

    CAS  PubMed  Article  Google Scholar 

  55. 55.

    Yamane T, Tateishi A, Cho S, et al. The effects of hyperthermia on the spinal cord. Spine. 1992;17(11):1386–91.

    CAS  PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to A. Nicholas Kurup.

Ethics declarations

Conflicts of interest

A. N. Kurup has received a research grant from Galil Medical; has received royalties from UpToDate, Inc.; outside the submitted work. J. M. Morrois is a paid consultant for Medtronic; outside the submitted work. M. R. Callstrom has received research grants from General Electric Medical, Thermedical, Galil Medical, and Siemens Medical; has received royalties from UpToDate, Inc.; and is a paid consultant for Covidien, Medtronic, and Perseon Medical; outside the submitted work. All other authors have no potential conflicts of interest to disclose.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kurup, A.N., Schmit, G.D., Morris, J.M. et al. Avoiding Complications in Bone and Soft Tissue Ablation. Cardiovasc Intervent Radiol 40, 166–176 (2017). https://doi.org/10.1007/s00270-016-1487-y

Download citation


  • Ablation
  • Cryoablation
  • Radiofrequency ablation
  • Musculoskeletal
  • Bone tumors