Longitudinal Radiographical Changes Following Minimally Invasive Ablation and Cementoplasty of Osteolytic Vertebral...

Background: For orthopedic oncology patients who are poor candidates for open spine surgery, minimally invasive radiofrequency ablation and cementoplasty (RFA/C) is becoming increasingly popular for managing osteolytic vertebral metastases. Purpose: We sought to characterize long-term changes in vertebral body radiographical parameters and potential risk of adjacent fractures occurring. Methods: A single-institution, retrospective study of all patients receiving RFA/C for osteolytic thoracic or lumbar vertebral body metastases from 2017 to 2023 was conducted. Vertebral body integrity was assessed by column height changes (anterior, middle, and posterior 1/3), local vertebral angle, and indirect bone mass assessment (at 3, 6, 12, and 24 months postoperatively). The latter was assessed via Hounsfield unit (HU) changes on axial computed tomography. Adjacent vertebral fractures were defined as within 3 vertebral levels above or below index site. Treatment history including radiation therapy was tracked. Results: A total of 54 vertebral levels (26 patients; mean age 59.8 ± 19.0 years; 18 females) were included (mean follow-up 15.8 ± 13.8 months). HU (bone mass proxy) stabilized after RFA/C. Except for middle column height increasing at 3 months, no column height or local angle deformity changes were detected. Adjacent fracture occurred in 4 patients (15.4%); all 4 demonstrated systemic cancer progression. Conclusions: Our findings suggest that RFA/C may provide effective long-term stabilization of the index site that is maintained for at least 1 year postoperatively. All patients who experienced an adjacent fracture occurrence demonstrated radiographic evidence of cancer progression surrounding the treatment sites that appeared unrelated to the procedure itself.