| Objective:To investigate the therapeutic effectiveness of percutaneous kyphoplasty (PKP) combined with radiofrequency ablation (RFA) on spinal metastatic tumor, and compare with which of PKP only. To observe the imageological changes of vertebras after PKP combined with RFA therapy or PKP only. To analysis the ratio, distribution and relative influence factors of bone cement's exosmosis on these two therapies.Materials and Methods:78 patients with spinal metastatic tumor received PKP combined with RFA or PKP only during January 2008 to May 2010 in Second Xiangya Hospital and Xiangtan central hospital were retrospectively analyzed.102 vertebras from 65 patients with complete information were included in study.61 vertebras from 34 patients belongs to PKP and RFA group, and 43 vertebras from 31 patients belongs to PKP only group. Visual Analogue Scale (VAS), WHO standards for pain relief and Oswestry disability index (ODI) were used to investigate the clinical therapic effects in different time (before surgery,1 day,1 week,1 month, 3 month and 6 month after surgery), obtained data were statistically analyzed using t test of independent samples. To investigate the imageological changes of centrum, the heights of centrum's front edge and middle part and the cobb angle were measured on digital X-ray photos before and after surgery respectively, obtained data were statistically analyzed using t test of independent samples. To evaluate whether there is bone cement exosmosis, and the distribution of bone cement exosmosis if there is, all imageological data for each patients were reviewed in the department of spine surgery of each hospital, obtained data were statistically analyzed using chi-square test of R x C Contingency Tables.Results:1. VAS scoresFor PKP with RFA group, the VAS score is 7.81±0.61 before operation, and 3.10±0.51 on 1 day after operation, and 2.38±0.29, 2.49±0.36,2.59±0.37,2.63±0.29 on 1 week,1 month,3 month and 6 month after surgery respectively. Significant statistical difference was found (P<0.05) when comparing scores before and after operation using t test, indicating significant pain relief. There is no significant statistical difference (P>0.05) when comparing scores of various time after operation using ANOVA test, indicating steady pain relief during 6 months after operation. For PKP-only group, the VAS score is 7.50±0.88 before operation, and 3.72±0.41 on 1 day after operation, and 2.37±0.36, 2.59±0.39,2.47±0.23,3.48±0.33 on 1 week,1 month,3 month and 6 month after surgery respectively. Significant statistical difference was found (P<0.05) when comparing scores before and after operation using t test, indicating significant pain relief. Using ANOVA test, there is no significant statistical difference (P> 0.05) when comparing scores of 1 week,1 month and 3 month after operation, indicating steady pain relief during 3 months after operation, but the statistical difference was significant (P< 0.05) on 6 month after operation, indicating the pain is worsen than that of 3-month-after-operation. When comparing the PKP with RFA group and PKP-only group using t test of independent samples, there is no significant difference (P> 0.05) between these two groups for scores of 1 day,1 week,1 month and 3 months after operation respectively, but significant difference was found (P<0.05) between these two groups for scores of 6 months after operation.2. Pain relief evaluation using WHO standardsFor PKP with RFA group, effective rate of pain relief was 82.3% (28/34) on 1 day after operation,91.2%(31/34) on 1 week after operation, 87.5%(28/32) on 1 month after operation,87.1%(27/31) on 3 months after operation and 86.7%(26/30) on 6 months after operation. For PKP-only group, effective rate of pain relief was 80.6%(25/31) on 1 day after operation,87.1%(26/31) on 1 week after operation,86.7%(26/30) on 1 month after operation,83.3%(25/30) on 3 months after operation and 60.7%(16/28) on 6 months after operation. Significant statistical difference were found (P<0.05) when comparing the pain intensity between before and after operation using t test. When comparing the PKP with RFA group and PKP-only group using z test of independent samples, there is no significant difference (P>0.05) between these two groups for pain relief of 1 day,1 week,1 month and 3 months after operation respectively, but significant difference was found (P<0.05) between these two groups for scores of 6 months after operation.3. Oswestry Disability IndexFor PKP with RFA group, the ODI score is 71.15±0.83 before operation, and 58.82±0.59 on 1 day after operation, and 41.55±0.51, 41.59±0.64,43.67±0.89,46.47±0.47 on 1 week,1 month,3 month and 6 month after surgery respectively. Significant statistical difference was found (P<0.05) when comparing scores before and after operation using t test, indicating significant improvement of daily life functions. Significant statistical difference was also found (P<0.05) when comparing scores of various time after operation using ANOVA test, indicating the daily life function was steady improved during 6 months after operation. For PKP-only group, the ODI score is 69.81±0.59 before operation, and 58.06±0.82 on 1 day after operation, and 42.63±0.69, 42.01±0.63,43.46±0.54,57.69±0.69 on 1 week,1 month,3 month and 6 month after surgery respectively. Significant statistical difference was found (P<0.05) when comparing scores before and after operation using t test, indicating significant improvement of daily life functions. Using ANOVA test, Significant statistical difference was also found (P<0.05) when comparing scores before surgery and which of 1 week,1 month,3 month and 6 months after operation, indicating the daily life function was steady improved after operation, but there is no significant statistical difference (P>0.05) when comparing various times after operation, indicating the daily life function remain steady during the 6 months after surgery. Significant statistical difference was found P> 0.05) when comparing the ODI scores of 6 months after surgery between each group.4. Imageological changesBefore operation, the height of centrum's front edge was 19.5±1.5mm, and was 25.4±1.1 mm for middle part, the Cobb angle was 25.1±5.0°for PKP with RFA group. For PKP-only group, the height of centrum's front edge was 19.1±1.4mm, and was 25.2±1.0mm for middle part, the Cobb angle was 23.2±3.8°. After operation, the height of centrum's front edge was 25.7±1.2mm, and 29.7±1.3mm for middle part, the Cobb angle was 10.7±2.8°for PKP with RFA group. For PKP-only group, the height of centrum's front edge was 23.0±1.5mm, and 27.0±1.2mm for middle part, the Cobb angle was 17.6±2.5°. When comparing the height of centrum's front edge before and after operation using t test for independent samples, there are significant statistical difference (P< 0.05) for both PKP with RFA group and PKP-only group. When comparing the height of centrum's middle part before and after operation using t test for independent samples, there are significant statistical difference (P< 0.05) for both PKP with RFA group and PKP-only group. After operation, there are significant statistical difference (P< 0.05) for centrum's front edge, middle part and Cobb angle when comparing PKP with RFA group and PKP-only group.5. Exosmosis of bone cementThe ratio of exosmosis on PKP with RFA group was 21.3% and 44.6% on PKP-only group. Significant statistical difference was found (P <0.05) when comparing these two groups using chi-square test of R x C Contingency Tables. The ratio of exosmosis on PKP with RFA group is lower than PKP-only group, and the ratio of exosmosis type C and type D is also lower than PKP-only group.Conclusion:Treatment on spinal metastatic tumor using PKP combined with RFA therapy can significant relieve pain, effectively eliminate tumor and obviously improve patients' daily life function. The effects of pain-relief is lasting longer than PKP only, and the patients' quality of life is better after operation. Using PKP combined with RFA therapy, the centrum's height is restored better, the centrum's strength and the spine's stability is improved better than using PKP only. Using PKP combined with RFA therapy, the exosmosis of bone cement is rarer than using PKP only. PKP combined with RFA is a secure therapy for treatment on spinal metastatic tumor.
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