Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist

To evaluate and classify underlying mechanisms of adverse outcomes after percutaneous computed tomography (CT)-guided cryoablation for palliation of painful musculoskeletal metastatic disease.

Data were collected for patients who underwent CT-guided percutaneous palliative cryoablation for painful musculoskeletal metastatic disease between January 2010 and December 2012. Cases with adverse outcomes or suboptimal response were identified and classified according to the Society of Interventional Radiology (SIR) classification system for complications by outcome and according to underlying mechanism of the outcome as delineated on follow-up examination.

There were 61 patients who received ablation for painful musculoskeletal metastatic disease. Six patients with adverse outcomes were identified. Two were minor complications (A, n = 1; B, n = 1), and four were major complications (C, n = 1; D, n = 3). Four patients incurred sequelae related to damage of ancillary structures included in the ablation zone, and two patients developed complete fractures after ablation of lesions in weight-bearing bones.

Complete cryoablation of a painful musculoskeletal metastatic lesion may lead to ancillary damage of adjacent structures or fracture in weight-bearing bones.