Safety, Efficacy, and Adjacent-level Fracture Risk Following Vertebral Augmentation and Radiofrequency Ablation for the Treatment of Spine Metastases in Patients with Cancer

Purpose To evaluate the safety and efficacy of vertebral augmentation (VA) and radiofrequency ablation (RFA) for treating pathologic spinal fractures in patients with cancer and adjacent fracture risk following treatment. Materials and Methods This single-institution retrospective study, conducted from January 2017 to September 2020, included patients with cancer who underwent percutaneous VA with or without spine RFA for pathologic spine compression fractures. The primary outcome was pain reduction, assessed using the 10-point visual analog scale before the procedure, at first follow-up, and 2-4 weeks after the procedure. Logistic regression was performed to identify factors associated with epidural cement leak. Results A total of 638 spinal levels in 335 patients (median age, 65 years [IQR, 58-74 years]; 147 female, 188 male) were treated. Epidural tumor and retropulsion of bone fragments were present in 15% (93 of 638) and 13% (81 of 638) of treated levels, respectively, while posterior wall erosion was observed in 30% (190 of 638). Substantial pain improvement (greater than two-point reduction) occurred in 81% (519 of 638) of cases. Factors associated with decreased risk of epidural cement leak included RFA (42% no leak vs 38% leak, P = .03) and lumbar treatments (49% no leak vs 38% leak, P = .02). Adjacent-level fractures occurred in 10.4% of patients. The total complication rate (National Cancer Institute Common Terminology Criteria for Adverse Events grade 3 or higher) was 0.6% (four of 638). Conclusion VA and RFA are safe and efficacious treatments for spine fractures in patients with cancer.