To determine the effect of radiofrequency ablation (RFA) in conjunction with kyphoplasty on pain relief and analgesic requirements in patients with painful metastatic disease to the spine.

Introduction:
The incidence of spine metastasis seems to be increasing due to the extended survival of cancer patients and improved detection with advanced imaging studies.1 Many oncology patients may not be a candidate for traditional surgical treatment. Radiofrequency ablation in conjunction with kyphoplasty represents an effective alternative treatment for spinal metastasis morbidity.

Aims/

Objectives:
To determine the effect of radiofrequency ablation (RF) in conjunction with kyphoplasty on pain relief and analgesic requirements in patients with painful metastatic disease to the spine.

Methods:
Between 3/2019 and 8/2022, 59 kyphoplasty/RF ablations were performed. The median age was 63 years old (IQR, 55-69) with a male-to-female ratio of 0.97. The primary neoplastic diseases were as follows: multiple myeloma (n=17, 28.8%), breast (n=15, 25.4%), lung (n=7, 11.9%), prostate (n= 6, 10.2%), lymphoma and colorectal (each n= 3, 5.1%), urothelial (n= 2, 3.4%), thyroid, pancreas adenocarcinoma, renal cell, and metastatic adenoid cystic carcinoma (each n=1, 3.3%). Pain relief was evaluated by the highest visual analogue scale (VAS) score before and within 3-months after the procedure. The number of non-opioid and opioid pain medications that were taken before, at 1-mo, and 3-mo after the procedure was recorded. A two tailed p value < 0.05 was considered statistically significant.

Results:
Technical success was achieved in all patients. The median VAS score decreased from 10 (IQR, 8-10) to 2(IQR, 0-4) after the procedure (p < 0.001) and 2 (IQR, 2-3) at 3 months after procedure (p < 0.001). Table 1 demonstrates the number (and percentages) of patients who were taking non-opioid and opioid analgesics before the Kyphoplasty/ablation, and at 1-mo and 3-mo after the procedure. Overall, use of opioid medications decreased at 1-mo and 3-mo after the procedure.

Conclusion:
RFA in conjunction with kyphoplasty appears to provide meaningful clinical improvement in VAS pain scores and decrease requirements for narcotic medications in patients with metastatic disease to the spine.

References:
1. Bilsky M H, Lis E, Raizer J, Lee H, Boland P. The diagnosis and treatment of metastatic spinal tumor. Oncologist. 1999;4(06):459–469.