Evaluation of the therapeutic efficacy of precise microwave ablation combined with spinal tumor separation surgery for managing spinal metastases

Spinal metastases represent a significant clinical challenge, often resulting in severe pain, neurological dysfunction, and substantial symptom burden. Surgical intervention remains a primary treatment modality for patients with spinal instability or neurological compromise; however, the optimal surgical strategy for minimizing operative morbidity while achieving effective decompression remains debated. This study aimed to evaluate the clinical efficacy of precise microwave ablation (MWA) combined with spinal tumor separation surgery compared with tumor separation surgery alone in the treatment of thoracolumbar metastases. A retrospective analysis was conducted on 83 patients with thoracolumbar metastases who underwent surgery at the General Hospital of the Chinese People’s Liberation Army between January 2020 and December 2022. Patients were divided into two groups: the study group (n = 34) received precise MWA combined with spinal tumor separation surgery, while the control group (n = 49) underwent tumor separation surgery alone. Clinical outcomes included operative time, intraoperative blood loss, visual analog scale (VAS) pain scores, Frankel neurological grading, perioperative complications, and overall survival. The follow-up period ranged from 6 to 28 months. No significant differences were observed between groups in preoperative Tomita scores, modified Tokuhashi scores, spinal instability neoplastic scores (SINS), or Frankel grades (all P > 0.05). Compared with the control group, the study group demonstrated significantly reduced intraoperative blood loss (956.91 ± 150.02 mL vs. 1482.52 ± 110.01 mL, P < 0.001) and shorter operative time (279.61 ± 32.01 min vs. 306.03 ± 28.04 min, P < 0.001). At 1 month postoperatively, the study group exhibited significantly lower VAS pain scores (1.72 ± 1.01 vs. 2.41 ± 0.77, P = 0.0013). Neurological improvement rates (94% vs. 91%, P = 0.69), perioperative complication rates (2.9% vs. 4.1%, P = 0.79), and overall survival did not differ significantly between groups. The integration of precise microwave ablation with spinal tumor separation surgery is associated with reduced intraoperative blood loss, shorter operative time, and improved short-term pain control without increasing complication rates or compromising neurological outcomes. This combined approach may represent a valuable adjunctive surgical technique for appropriately selected patients with thoracolumbar spinal metastases, particularly in palliative settings where minimizing operative burden and achieving effective pain relief are key treatment goals.