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Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update

  • Neuro-oncology (GJ Lesser, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Spinal metastases are the most commonly encountered tumour of the spine, occurring in up to 40% of patients with cancer. Each year, approximately 5% of cancer patients will develop spinal metastases. This number is expected to increase as the life expectancy of cancer patients increases. Patients with spinal metastases experience severe and frequently debilitating pain, which often decreases their remaining quality of life. With a median survival of less than 1 year, the goals of treatment in spinal metastases are reducing pain, improving or maintaining level of function and providing mechanical stability. Currently, conventional treatment strategies involve a combination of analgesics, bisphosphonates, radiotherapy and/or relatively extensive surgery. Despite these measures, pain management in patients with spinal metastases is often suboptimal. In the last two decades, minimally invasive percutaneous interventional radiology techniques such as vertebral augmentation and radiofrequency ablation (RFA) have shown progressive success in reducing pain and improving function in many patients with symptomatic spinal metastases. Both vertebral augmentation and RFA are increasingly being recognised as excellent alternative to medical and surgical management in carefully selected patients with spinal metastases, namely those with severe refractory pain limiting daily activities and stable pathological vertebral compression fractures. In addition, for more complicated lesions such as spinal metastasis with soft tissue extension, combined treatments such as vertebral augmentation in conjunction with RFA may be helpful. While combined RFA and vertebral augmentation have theoretical benefits, comparative trials have not been performed to establish superiority of combined therapy. We believe that a multidisciplinary approach as well as careful pre-procedure evaluation and imaging will be necessary for effective and safe management of spinal metastases. RFA and vertebral augmentation should be considered during early stages of the disease so as to maintain the remaining quality of life in this patient population group.

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Authors and Affiliations

  1. Interventional Radiology Service–Department of Radiology, Austin Hospital, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia

    Ning Mao Kam MD, Julian Maingard MBBS, Dinesh Ranatunga FRANZCR, EBIR & Duncan Brooks FRANZCR, CCINR, EBIR

  2. Department of Interventional Radiology–Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Hong Kuan Kok FFRRCSI, FRCR, EBIR

  3. Interventional Neuroradiology Service–Radiology Department, Austin Hospital, Melbourne, Australia

    Julian Maingard MBBS, Duncan Brooks FRANZCR, CCINR, EBIR & Hamed Asadi FRANZCR, CCINR, EBIR

  4. Interventional Neuroradiology Service–Radiology Department, St Vincent’s Hospital, Melbourne, Australia

    Duncan Brooks FRANZCR, CCINR, EBIR

  5. Department of Radiology, Tallaght Hospital, Dublin, Ireland

    William C. Torreggiani FFRRCSI, FRCR

  6. Musculoskeletal Division, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada

    Peter L. Munk FRCPC, FSIR

  7. Interventional Radiology Service–Department of Radiology, Beaumont Hospital, Dublin, Ireland

    Michael J. Lee FFRRCSI, FRCR, EBIR, FSIR

  8. Interventional Neuroradiology Unit–Monash Imaging, Monash Health, Melbourne, Australia

    Ronil V. Chandra FRANZCR, CCINR & Hamed Asadi FRANZCR, CCINR, EBIR

  9. Department of Imaging, Monash University, Melbourne, Australia

    Ronil V. Chandra FRANZCR, CCINR

  10. School of Medicine–Faculty of Health, Deakin University, Waurn Ponds, Geelong, Australia

    Julian Maingard MBBS & Hamed Asadi FRANZCR, CCINR, EBIR

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  1. Ning Mao Kam MD
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Correspondence to Ning Mao Kam MD.

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Conflict of Interest

Ning Mao Kam, Julian Maingard, Hong Kuan Kok, Dinesh Ranatunga, Duncan Brooks, William C. Torreggiani, Peter L. Munk, Michael J. Lee, Ronil V. Chandra and Hamed Asadi declare they have no conflict of interest.

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Kam, N.M., Maingard, J., Kok, H.K. et al. Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update. Curr. Treat. Options in Oncol. 18, 74 (2017). https://doi.org/10.1007/s11864-017-0516-7

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