Percutaneous Vertebroplasty Combined With Radiofrequency Ablation Therapy For Spinal Metastatses

ObjectiveTo assess the Security and clinical results of percutaneous vertebroplasty (PVP) combied with radiofrequency ablation(RFA) therapy for spinal metastateses, and compare with PVP treatment, analysis of whether RFA will improve the efficacy; analysis the rate and type of leakage of PMMA, combine with RFA and group PVP, analysis of whether RFA reduces the leakage of Bone cement.Materials and MethodsA retrospective study was conducted to review 179 consecutive PVP combined RFA or PVP procedures on 159 cases of spinal metastatese from January 2008 to December 2009 in Interventional Radiology Department Shanghai 6th People's Hospital, choose complete clinical data, imaging follow-up data of 115 cases, 186 vertebral bodys as the research object, in which PVP +RFA group (A group) 53 cases, 84 vertebral bodys; PVP group (B group) 62 cases, 102 vertebral bodys.Observation and analysis of the efficacy and leakage of PMMA of the two groups. The visualanalogseale scale(VAS),WHO standards for pain relief and Owestry disability index (ODI) were recorded completely before and after(1 day,1week,1 month, 3month and 6 month)the procedures. These data was analyzed using paired-samples T test. Radiologists Pingyue analyse surgery and postoperative images, to determine whether bone cement leakage and determine the type: A,perivertebral soft tissue leakage, B, spinal epidural and foraminal leakage, C,perivertebral vascular leakage, D, adjacent disc leakage. Analysis of two groups of bone cement leakage rate and leakage types, related factors and clinical symptoms caused by leakage. The frequencies and leakages were analyzed using Chi-square test.Results All procedures were successfully completed under DSA guide.The average preoperative VAS seore of PVP+RFA group was 8.02±1.87, and PVP was7.92±1.78, there was no significant difference between the two groups (P> 0.05), by independent samples t test. Pain relief, according to WHO criteria, A group: the analgesic efficacy was satisfactory for 83.0%(44/53) of patients after 1 day, 92.5%(49/53) patients after 1 week, 89.6%(43/48) of patients after 1 month, 91.1%(41/45)of patients after 3 month, 87.8%(36/41) of patients after 6 month. B group: The analgesic efficacy was satisfactory for 80.6%(50/62) of patients after 1 day, 85.5%(53/62) patients after 1 week, 86.2%(50/58) of patients after 1 month, 85.5%(47/55) of patients after 3 month, 82.3%(42/51) of patients after 6 month. Patients had significant pain relief(P<0.05) in two groups. The two groups after 1 day, the pain that improved (P<0.05), after 1 week efficacy has been further consolidated, 1 month, 3 months, 6 months, the efficacy and stability in the following.The average preoperative ODI of A group was 81.28±10.05, B group the 78.67±9.12, there was no significant difference between the two groups (P> 0.05), by independent samples t test. Patients had significant improvement of daily activity function (P<0.05) in two groups. The two groups after 1 day, the activity capabilities that improved(P<0.05) , after 1 week efficacy has been further consolidated, 1 month, 3 months, 6 months , the efficacy and stability in the following.RFA without bleeding, skin burns, never and spinal cord injury complications. The rate of bone cement leakage,A group was 21.7% (15/69), B group was 44.2 (42/95 ), analyzed using Chi-square test, there is significant difference(P <0.05); A group was no obvious symptoms of nerve root compression, B group, 2 patients with symptoms of nerve root compression. No pulmonary embolism and other serious complications.There were no significant difference between the two groups (P> 0.05) after 6 months, by independent samples t test.ConclusionsPVP+RFA and PVP have excellent effects for spinal metastases,relief pain quickly,improve activities function and quality of life in patients. PVP+RFA can kill the tumors and enhance the strength of the vertebral body,improve the stability of the spine;This treatment is technically minimally-invasive and safe with reliable clinical results, there were no significant difference them; A group of post-operative complications of the leakage of PMMA is less than B group,RFA can reduce the leakage of bone cement during the PVP.