# Radiofrequency Ablation of Painful Spinal Metastasis: A Systematic Review
## 4 Discussion  
Painful spinal metastases present a significant challenge in oncologic care, burdening patients' quality of life and functional status. The quest for effective and minimally invasive analgesic treatments is therefore paramount. This systematic review was conducted to synthesize the evidence on radiofrequency ablation (RFA).  
Our findings suggest that RFA is a highly effective and safe modality for pain palliation in these patients. Specifically, this review of 33 studies encompassing 1336 patients demonstrated that 85% of studies reported highly effective pain management (a reduction of \(\geq\)4 points on a pain scale), and all included studies achieved at least a partial pain response according to ICPRE criteria. Furthermore, RFA was associated with a low overall complication rate of 2.11% (grade I-III), with no life-threatening (grade IV-V) complications reported.  
The analysis indicates RFA's potential to achieve pain relief in the short to mid-term (from 48-72 h to 24 weeks), contributing to improved functionality and overall quality of life.  
Mean pain scores decreased significantly from baseline (7.56/10) within 24-72 h (3.65) and remained low at 4 weeks (2.99), 12 weeks, and 24 weeks (2.70).  
It is crucial to consider the results in the context of the limitations associated with conventional treatment modalities for spinal metastases. The ability to achieve pain management within 48-72 h represents a substantial clinical advancement, particularly in light of the 3-6 week timeframe typically associated with radiation therapy for pain palliation [45], suggesting that RFA can be effectively utilized either as a complementary treatment for pain control or as an alternative when radiotherapy has failed or is contraindicated.  
This finding resonates with the OPuS One trial [21], the largest, prospective multicenter study that specifically evaluated RFA for metastatic lytic bone disease independent of radiation therapy and similarly found significant and durable pain reduction following the procedure.  
The safety profile of RFA, as highlighted in our review, further strengthens its case for wider adoption. Indeed, we found a relatively low rate of complications. No life-threatening complications (grade IV-V) were reported, and the overall complication rate was 2.11% (grade I-III). These findings are consistent with previous studies reporting low complication rates (3.0%) associated with RFA for spinal metastases [16; 47; 46].  
However, it is important to acknowledge that RFA is not without risk. Complications such as temporary post-procedural radicular pain, asymptomatic spinal cord edema, and transient neurological motor deficits were observed.  
While RFA is generally considered safe, careful patient selection and meticulous technique are crucial to minimize the risk of complications. The safety profile of RFA can befurther improved by combining it with vertebplasty, which can reduce the risk of vertebral fracture [29]. Additionally, the use of bipolar RFA with increased target temperature has been shown to have an excellent safety profile and high rates of pain relief and local tumor control [6].  
While our review predominantly included retrospective case series, the consistency of positive outcomes across these studies from different countries, coupled with the robust findings from prospective trials, provides evidence for the efficacy and safety of RFA. To further validate these findings and establish the long-term durability of pain relief, future research should prioritize prospective studies with larger sample sizes and extended follow-up periods. This includes exploring its role in combination with other therapies, such as radiotherapy, or against other minimally invasive techniques such as cryoablation and microwave ablation, to develop comprehensive and personalized treatment strategies.