Spinal Radiofrequency Ablation Combined
with Cement Augmentation for Painful
Spinal Vertebral Metastasis: A Single-Center
Prospective Study
Authors: Sayed Dawood 
Published: February 2021

Background: The spine is the most common site of skeletal metastatic disease. Vertebral body
metastases (VBM) can cause crippling pain, fractures, and spinal cord compression. Radiofrequency
ablation (RFA) is a minimally invasive technique that has proven to be a safe method of targeted
tissue destruction. Studies have shown that RFA combined with cement vertebral augmentation is
safe and effective and has been associated with significant improvements in pain and quality of life.
Objectives: The purpose of this study was continued evaluation of the safety and efficacy of this
technique.
Study Design: Prospective cohort.
Setting: A single academic medical center.
Methods: Patients undergoing RFA with cement vertebral augmentation for a painful thoracic or
lumbar VBM were eligible for inclusion. Additional inclusion criteria included pain concordant with
a metastatic lesion on cross-sectional imaging, aged 18 years or older, and considered candidates
for spinal tumor ablation by the operating physician. Patients with vertebral metastatic disease
in the cervical spine or patients with spinal cord compression from posterior tumor extension
were excluded. Ablation within each VBM was performed using a bipolar radiofrequency probe
with an extensible electrode and available articulation, permitting vertebral body navigation
percutaneously. Patients were evaluated at baseline, 3 days, one week, one month, and 3 months
using the Numeric Rating Scale (NRS-11) and Functional Assessment of Cancer Therapy-General
7 (FACT-G7) to assess pain and quality-of-life, respectively. A one-sample t test was performed,
and 95% confidence intervals were calculated to assess changes in average NRS-11 and FACT-G7
scores.
Results: A total of 30 patients met inclusion criteria and underwent RFA of one or more VBM.
Patients with 13 different primary cancers types underwent treatment. Patients received RFA to
either one (n = 26; 87%) or 2 vertebral body levels (n = 4; 13%). Of the 34 levels, 13 were thoracic
vertebra (38%) and 21 were lumbar vertebra (62%). Average NRS-11 scores decreased from a
baseline of 5.77 to 4.65 (3 days; P = 0.16), 3.33 (one week; P < 0.01), 2.64 (one month; P < 0.01),
and 2.61 (3 months; P < 0.01). FACT-G7 increased from a baseline average of 13.0 to 14.7 (3 days;
P = 0.13), 14.69 (one week; P = 0.15), 14.04 (one month; P = 0.35), and 15.11 (3 months; P =
0.07). No major adverse events were reported.
Limitations: A heterogeneous patient population, small sample size, and potential confounders
of concurrent variable adjuvant therapies were limitations. Additionally, most patients received
both cement augmentation and targeted RFA, making it difficult to distinguish independent
analgesic benefits of the therapies.
Conclusions: This study demonstrates that minimally invasive targeted RFA with cement
augmentation of spinal metastatic lesions is an effective treatment for patients with VBM.
Key words: Cancer, cancer pain, spinal metastasis, radiofrequency ablation, tumor ablation,
cement augmentation