The local tumor control rates of percutaneous thermal ablation of spinal osseous metastatic disease have been reported at 70% to 96% in several case series [144-146]. Implementation of appropriate patient selection guidelines, the optimal choice of ablation modality, and the use of thermal protection when necessary are major contributors to improved treatment outcomes. RFA is typically used to treat osteolytic or mixed osteolytic-osteoblastic vertebral (body and/or posterior elements) tumors without soft tissue components. RFA is often ineffective in treating primarily osteoblastic lesions because of the high impedance of densely sclerotic bone [145]. Microwave ablation uses electromagnetic waves to agitate water molecules, producing friction and heat that induces cellular death via coagulation necrosis. Microwave ablation is more effective in high-impedance tissues like bone because poor thermal conduction in bone may be at times a limiting factor in RFA. Osseous relative permeability and low conduction help microwaves penetrate deeper and are more effective in thermal ablation than RFA. Microwave ablation is a promising, safe, and effective treatment for osseous tumors, resulting in both a reduction in pain and a degree of locoregional control of the disease process [143]. Cryoablation results in the formation of a hypoattenuating ice ball, which is readily identified by CT, beyond which tissues are safe from thermal injury. Additional advantages of cryoablation are decreased intraprocedural and postprocedural pain, the ability to use multiple probes in various orientations to achieve additive overlapping ablation zones, and efficiency in treating osteoblastic metastases [147]. Typically followed VA procedure patients should still be considered for radiation. Vertebral Compression Fractures Percutaneous Vertebral Augmentation VA is a safe and effective treatment for vertebrae weakened by neoplasia [148].
Management of Vertebral Compression Fractures PCAs. The local tumor control rates of percutaneous thermal ablation of spinal osseous metastatic disease have been reported at 70% to 96% in several case series [144-146]. Implementation of appropriate patient selection guidelines, the optimal choice of ablation modality, and the use of thermal protection when necessary are major contributors to improved treatment outcomes. RFA is typically used to treat osteolytic or mixed osteolytic-osteoblastic vertebral (body and/or posterior elements) tumors without soft tissue components. RFA is often ineffective in treating primarily osteoblastic lesions because of the high impedance of densely sclerotic bone [145]. Microwave ablation uses electromagnetic waves to agitate water molecules, producing friction and heat that induces cellular death via coagulation necrosis. Microwave ablation is more effective in high-impedance tissues like bone because poor thermal conduction in bone may be at times a limiting factor in RFA. Osseous relative permeability and low conduction help microwaves penetrate deeper and are more effective in thermal ablation than RFA. Microwave ablation is a promising, safe, and effective treatment for osseous tumors, resulting in both a reduction in pain and a degree of locoregional control of the disease process [143]. Cryoablation results in the formation of a hypoattenuating ice ball, which is readily identified by CT, beyond which tissues are safe from thermal injury. Additional advantages of cryoablation are decreased intraprocedural and postprocedural pain, the ability to use multiple probes in various orientations to achieve additive overlapping ablation zones, and efficiency in treating osteoblastic metastases [147]. Typically followed VA procedure patients should still be considered for radiation. Vertebral Compression Fractures Percutaneous Vertebral Augmentation VA is a safe and effective treatment for vertebrae weakened by neoplasia [148].