Application of Separation Surgery Combined with Radiofrequency Ablation and Bone Cement Strengthening in Thoracolumbar Metastasis
Summary
This study investigates the efficacy of combining separation surgery with radiofrequency ablation and radiotherapy in treating thoracolumbar metastatic tumors.
Abstract
The spine is a common site for metastatic tumors, with 5%-10% of patients developing epidural spinal cord compression (ESCC), which significantly reduces their quality of life and accelerates the process of death. When total en-bloc spondylectomy (TES) radical surgery does not achieve the desired tumor control, palliative care remains the primary treatment option. Traditional laminar decompression or partial tumor resection can only relieve local compression. Although the surgical trauma and complications are less, these methods cannot effectively address tumor recurrence and secondary compression. Therefore, separation surgery combined with radiofrequency ablation and bone cement strengthening was used to treat thoracolumbar metastatic tumors, aiming to achieve good clinical results. In this protocol, the steps and key points of separation surgery combined with radiofrequency ablation and bone cement reinforcement for thoracolumbar metastatic tumors are introduced in detail. Meanwhile, the clinical data of 67 cases of thoracolumbar metastatic tumors in our hospital meeting the inclusion criteria were retrospectively analyzed. Different treatment methods divided the patients into two groups: separation surgery combined with radiofrequency ablation and bone cement strengthening (group A, 33 cases) and the radiotherapy group (group B, 34 cases). All patients were evaluated using improved Tokuhashi, Tomita, SINS, and ESCC scores before treatment. VAS score, Frankel grading, and Karnofsky scores during different periods of the two treatments were compared to assess the clinical outcomes. Studies have shown that separation surgery combined with radiofrequency ablation and bone cement strengthening can significantly reduce pain, promote neurological function recovery, enhance mobility, and improve quality of life in treating thoracolumbar metastatic tumors.
Introduction
With the development of precision medicine, the survival rate of patients with malignant tumors has gradually increased, and the incidence of bone metastasis has also risen significantly. Spinal metastasis is the most common occurrence in patients with malignant tumors, accounting for approximately 60%-70%. Among these, 5%-10% of patients will suffer from epidural spinal cord compression (ESCC)1,2, which can result in bone-related events, such as localized pain, hypercalcemia, spinal instability, pathological fractures, spinal cord and nerve root compression, and other clinical symptoms. About 50% of patients will suffer from neurological dysfunction3, which dramatically reduces their quality of life and accelerates death.
The diagnosis and treatment of spinal metastases require multidisciplinary collaboration. Treatment of the primary tumor is fundamental, and surgical intervention plays a vital role in managing spinal metastases. The objectives of surgical treatment are to relieve pain, rebuild spinal stability, improve neurological function, control local tumor lesions, enhance the patient's quality of life, provide conditions for further treatments such as radiotherapy, chemotherapy, and immunotherapy, and even prolong life4. Conventional laminectomy or partial tumor resection only relieves local compression. Although the surgical trauma is minor and the incidence of surgical complications is low, these methods cannot effectively address tumor recurrence and secondary compression5.
Separation surgery involves performing a 360° annular decompression around the compressed spinal dura mater to ensure a safe gap of about 5-8 mm between the spinal dura mater and the tumor tissue for radiotherapy. Bone cement is used to separate the anterior affected vertebra, tumor body, and dura mater. Several clinical studies have shown6,7,8,9 that separation surgery combined with stereotactic radiotherapy has achieved satisfactory clinical efficacy in treating spinal metastatic tumors. However, there are issues such as significant surgical trauma, excessive bleeding, and re-progression of vertebral tumors after resection, which affect its therapeutic efficacy.
In clinical practice, our team observed that during separation surgery for spinal metastases, patients were prone to local progression of vertebral tumors and recurrent nerve compression symptoms while waiting for the incision to heal for subsequent radiotherapy. Radiofrequency ablation (RFA) is a minimally invasive treatment method widely used in clinical tumor hyperthermia. It uses biological heat generated during friction and ion collision to kill local tumor cells and coagulate the surrounding vascular tissues to form a reaction zone, thus destroying their blood supply10.
Therefore, separation surgery combined with radiofrequency ablation and bone cement reinforcement was used to treat thoracolumbar metastatic tumors. In this technical report, the steps and key points of separation surgery combined with radiofrequency ablation and bone cement reinforcement for thoracolumbar metastatic tumors are described in detail. Additionally, the clinical data of 67 patients with thoracolumbar metastases who met the inclusion criteria and were admitted to the General Hospital of Ningxia Medical University from January 2019 to January 2023 were retrospectively analyzed. These patients were categorized into two groups based on the different treatment approaches. The clinical efficacy of separation surgery combined with radiofrequency ablation and bone cement strengthening (group A, 33 cases) and the radiation therapy group (group B, 34 cases) in thoracolumbar metastatic tumors was evaluated using various observation indicators. This analysis provides a basis for selecting clinical treatment methods for spinal metastatic tumors.
A retrospective analysis was performed on 67 patients with thoracolumbar metastases who met the inclusion criteria and were admitted to our hospital from January 2019 to January 2023. The patients were divided into two groups based on different treatment methods: separation surgery combined with radiofrequency ablation and bone cement strengthening (group A, 33 cases) and the radiotherapy group (group B, 34 cases). The two groups were evaluated for age, gender, primary tumor, time of primary tumor occurrence, affected vertebral body, ESCC score, SINS score, Tomita score, and Tokuhashi score4. There was no statistical significance (P > 0.05) in these variables, indicating that the clinical baseline data were consistent between the two groups (Table 1).
Protocol
Representative Results
Discussion
Although the Tokuhashi score, Tomita score, SINS score, and ESCC score provide a solid evidence-based medical basis for selecting surgical treatment for patients with spinal metastatic tumors, developing an individualized and accurate treatment plan for patients remains a complex problem. Multidisciplinary comprehensive treatment methods are used, including traditional open surgery, minimally invasive surgery, radiotherapy, chemotherapy, and immunotherapy. Roy A. Patchell et al.14 designed a rando…
Disclosures
The authors have nothing to disclose.
Acknowledgements
None.
Materials
| Bone cement | Tecres S.P.A | 1230 | |
| CArm Xmedical equipment | Siemens Healthcare | Cios Spin | |
| CT machine | Siemens Healthcare | SOMATOM Force | |
| MRI machine | Siemens Healthcare | MAGNETOM Terra | |
| Pedicle screws | Shandong Weigao Medical Equipment Co., LTD | Premier-6.6mm*45mm | |
| Radio-frequency ablation instrument | Mianyang Leading Electronic Technology Co.,ltd. | LDRF-120S | |
| Radiofrequency ablation needle | Mianyang Leading Electronic Technology Co.,ltd. | RFDJ03 | |
| Radiofrequency Ablation Needle | Varian Clinac | IX | |
| Ultrasonic Osteotome System | Misonix INC | MXB-10 | |
| X-ray machine | Philips Investment Co., LTD. Medical system | XR/a |
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