Radiofrequency Ablation of Painful Spinal Metastasis: A Systematic Review

To systematically evaluate the effectiveness and safety of radiofrequency ablation (RFA) for managing pain caused by spinal metastases. This review aimed to consolidate evidence on RFA's analgesic efficacy and associated risks to inform clinical practice in palliative cancer care.

A systematic review adhering to PRISMA guidelines was conducted. Databases were searched for studies evaluating RFA for spinal metastases pain. Inclusion criteria specified: randomized or non-randomized studies (prospective/retrospective); ≥3 adult patients; RFA used alone or combined with other treatments; reported pre- and post-RFA pain assessments; English language publication. Data extracted included patient demographics, primary tumor type, lesion location, pain scores (e.g., NRS/VAS), and complications. Pain response was assessed using definitions including the International Consensus Pain Response Endpoints (ICPRE) and definitions for moderate (≥2-point reduction) and high (≥4-point reduction) effectiveness.

This review included 33 studies, totaling 1336 patients (53.7% female) and 1787 treated lesions. The majority (85%) of studies reported highly effective pain management (≥4-point pain score reduction). The remaining 15% showed moderate effectiveness (≥2-point reduction). All studies reported achieving at least a partial pain response per ICPRE criteria. Mean pain scores decreased significantly from baseline (7.56/10) within 24-72 h (3.65) and remained low at 4 weeks (2.99), 12 weeks, and 24 weeks (both 2.70). Common primary cancers were lung (27.6%), breast (26.2%), and genitourinary (11.3%). Lesions were primarily in the thoracic (47.9%) and lumbar spine (47.3%). Crucially, no life-threatening (grade IV-V) complications occurred. The overall rate of grade I-III complications was low at 2.11%.

This systematic review is limited by its study-level nature, preventing detailed subgroup analyses regarding specific metastasis characteristics or the impact of complementary therapies.

This systematic review suggests that RFA is a safe and effective treatment for pain control in patients with spinal metastases. It provides both rapid (within 24 h) and durable mid-term (up to 24 weeks) analgesia. The favorable safety profile, with a low complication rate, supports RFA as a valuable complimentary option within the multidisciplinary palliative management of painful spinal secondary tumors. Future randomized-controlled studies may help to further define its role when associated with other treatments.