Radiofrequency ablation for palliation of painful spinal metastases

Evidence-based recommendations on radiofrequency ablation 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 for palliation of painful spinal metastases is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wanting to do radiofrequency ablation for palliation of painful spinal metastases should:
Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that people and their families and carers understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of everyone having the 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).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
Patient selection should be done by a multidisciplinary team. The procedure should only be done by clinicians with training and expertise in vertebral interventions.
NICE encourages further research into the procedure. This should report details of patient selection, type of tumour and interventional procedures used.# 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.
Radiofrequency ablation is not usually done if the spinal metastases are close to neurological structures because of the risk of neurological injury.
This is a standalone radiofrequency ablation procedure and not an adjunct to vertebroplasty or kyphoplasty.