Meta Analysis Of Radiofrequency Ablation Combined With Vertebroplasty And Vertebroplasty Alone In The Treatment Of Spinal Metastases

Background:Spinal metastases are common late complications of malignant tumors,especially breast and prostate cancer,while spinal metastases are rare in patients with gastrointestinal malignant tumors.The malignant tumor cells planted and growing in the vertebral body erode the normal vertebral structure,produce tumor tissue and tumor bone tissue to replace the normal high-quality bone tissue,and cause pain,pathological fracture,spinal cord compression,spinal instability and other destructive bone complications.The surgical treatment of spinal metastases pursues surgical procedures with less trauma,quick recovery and good results,in order to make patients get as high quality of life as possible in the limited survival period.Radiofrequency ablation(RAF)is a coagulation and necrosis technique based on thermal effect,which produces high temperature by radiofrequency electrode to kill adjacent tumor tissue and nourishing blood vessels,so as to control tumor recurrence.However,RAF ablation of tumor tissue also destroys the stability of the vertebral body and increases the possibility of serious complications such as vertebral fracture and even spinal cord compression.Vertebroplasty(Vertebroplasty),also known as percutaneous cement vertebroplasty,including percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP),can be used to treat pain and pathological fractures caused by spinal metastases.However,vertebroplasty also has some defects such as incomplete destruction of tumor and leakage of bone cement.Objective:the purpose of this study is to compare the therapeutic effects of RAF combined with vertebroplasty and vertebroplasty alone by Meta analysis,so as to provide evidence-based medical evidence for clinical decision-making of spinal metastases.Methods:The literature retrieval strategy was established,the inclusion and exclusion criteria were determined,and the randomized controlled trial(RCT)or cohort study of RAF combined with vertebroplasty and vertebroplasty in the treatment of spinal metastases was searched in Chinese and English databases such as China knowledge Network(CNKI)and PubMed.The two researchers evaluated the quality of the included literature and extracted the outcome data.The outcome indicators included visual analog score(VAS),Oswestry dysfunction index(ODI),vertebral body height,bone cement leakage rate and tumor recurrence rate.Results:11 intervention clinical trials(2 RCT trials,9 cohort studies)published from 2016 to 2022 were included,involving 989 patients.The baseline data(age,sex and primary location of tumor,etc.)were not statistically significant(P>0.05).The results of Meta analysis showed that,compared with vertebroplasty alone,RAF combined with vertebroplasty was superior in pain relief[On the first day after surgery,MD=-0.31,95%CI(-0.25,-0.03),P=0.0003;On the 7th day after surgery,MD=-0.44,95%CI(-0.74,-0.14),P=0.004;At 3 months after surgery,MD=-0.38,95%CI(-0.49,0.28),P=0.02;At 6 months after surgery,MD=-1.05,95%CI(-1.33,-0.77),P<0.00001],dysfunction recovery[On the 7th day after surgery,MD=-2.52,95%CI(-3.77,-1.27),P<0.0001;At 1 month after surgery,MD=-2.19,95%CI(-3.54,-0.84),P=0.001;At 3 months after surgery,MD=-3.25,95%CI(-5.05,-1.46),P=0.0004;At 6 months after surgery,MD=5.80,95%CI(-14.83,-1.36),P=0.02],vertebral height recovery[Anterior height of vertebral body(AHV),MD=1.28,95%CI(0.86,1.70),P<0.00001;Intermediate height of vertebral body(IHV),MD=1.26,95%CI(0.92,1.60),P<0.00001],bone cement leakage rate[RR=0.28,95%CI=(0.19,0.42),P<0.00001],tumor recurrence rate[RR=0.25,95%CI(0.14,0.42),P<0.00001].About pain relief[At 1 month after surgery,MD=-0.50,95%CI(-1.21,0.20),P=0.16]and dysfunction recovery[On the first day after surgery,MD=0.42,95%CI(1.78,2.62),p=0.71],there were no significant differences.Conclusion:RAF combined with vertebroplasty is more effective in pain relief,dysfunction recovery and vertebral height recovery,and the postoperative bone cement leakage rate and tumor recurrence rate are significantly lower than those of vertebroplasty alone.There were no significant differences in pain relief at 1 month after operation and dysfunction recovery on the first day after operation.