Radiofrequency ablation as an adjunct to balloon kyphoplasty or percutaneous vertebroplasty for palliation of painful spinal metastases

Evidence-based recommendations on radiofrequency ablation as an adjunct to balloon kyphoplasty or percutaneous vertebroplasty for palliation of painful spinal metastases. This involves inserting a needle-like probe containing an electrode into the spinal metastases. This produces an electrical current that aims to relieve pain and other symptoms.

# Recommendations
Evidence on the safety and efficacy of radiofrequency ablation as an adjunct to balloon kyphoplasty or percutaneous vertebroplasty for palliation of painful spinal metastases is adequate to support using this procedure provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.
For auditing the outcomes of this procedure, the main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Patient selection should be done by a multidisciplinary team. The procedure should only be done by clinicians with training and expertise in kyphoplasty or vertebroplasty techniques.# The condition, current treatments and procedure

# The condition
Spinal metastases can affect quality of life by causing severe pain, functional impairment, vertebral fractures, nerve root impingement, spinal cord compression and hypercalcaemia.

# Current treatments
Treatment for spinal metastases is always palliative. It aims to reduce pain, improve and maintain function, provide mechanical stability and prevent further local tumour progression. Current treatment options include a combination of medical therapies (such as analgesics, systemic therapies including osteoclastic inhibitors such as bisphosphonates and denosumab, chemotherapy or hormone therapy), orthotic support, radiation therapy (external beam radiotherapy or stereotactic body radiotherapy) and minimally invasive localised percutaneous procedures such as cryoablation, photodynamic therapy, microwave ablation and radiofrequency ablation. These techniques may also be used with kyphoplasty or vertebroplasty to improve structural or mechanical stabilisation after tumour ablation. Open surgery (or surgery combined with radiotherapy) may be suitable for some people with spinal cord compression and vertebral fractures.

# The procedure
Radiofrequency ablation is a procedure for palliative treatment of spinal metastases. It is usually done in a day-case setting using a transpedicular or parapedicular approach under general anaesthesia or local anaesthesia with sedation. The approach is either percutaneous, endoscopic or surgical.
Under imaging guidance (fluoroscopy, CT or MRI), a radiofrequency probe is inserted into the spinal tumour. The radiofrequency probe is attached to a radiofrequency generator, which creates high-frequency, alternating current pulses that heat and destroy the tumour. This creates a cavity in the vertebral body. In this procedure, percutaneous vertebroplasty or balloon kyphoplasty is done at the same time with the aim of preventing subsequent fractures in the treated vertebrae.
Radiofrequency ablation is not usually done if the spinal metastases are close to neurological structures because of the risk of neurological injury.