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Percutaneous Thermal Ablation of Spine Metastasis

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Abstract

As patients with cancer are living longer, metastatic spine disease is becoming an ever-increasing burden in the oncology patient. While radiation is the current standard of care for painful metastatic spinal disease without associated mechanical instability or neurologic symptoms, radiation therapy alone may lead to insufficient pain relief and inadequate tumor control and may not prevent vertebral collapse. Furthermore, radiation therapy can lead to complications ranging from mild (e.g., skin irritation) to severe (e.g., postradiation myelopathy). As such, alternative minimally invasive, image-guided treatment strategies that do not interfere with systemic therapies have been developed to improve outcomes for this patient population. Two such modalities, radiofrequency ablation (RFA) and cryoablation, have demonstrated to be particularly useful tools for this endeavor. In this chapter, we will discuss the current indications for RFA and cryoablation in the treatment of spinal metastases and how each technique is performed. We also present the most current evidence regarding each modality’s efficacy in the treatment of patients with spinal metastases and the importance of supplemental cement augmentation. A discussion of their limitations and risk profiles will be provided so as to emphasize that a fundamental working knowledge of ablation principles and technologies is needed to perform these techniques safely.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California—San Francisco (UCSF), San Francisco, CA, USA

    Alexander Theologis MD

  2. Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA

    Jack W. Jennings MD, PhD

  3. Department of Orthopaedic Surgery, BJC Institute of Health, Washington University in St. Louis—School of Medicine, St. Louis, MO, USA

    Jacob M. Buchowski MD, MS

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  1. Alexander Theologis MD
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  2. Jack W. Jennings MD, PhD
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  3. Jacob M. Buchowski MD, MS
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Correspondence to Jacob M. Buchowski MD, MS .

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  1. Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, Texas, USA

    Rex A. W. Marco

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Theologis, A., Jennings, J.W., Buchowski, J.M. (2018). Percutaneous Thermal Ablation of Spine Metastasis. In: Marco, R. (eds) Metastatic Spine Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-76252-4_23

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