From the Departments of Oncology (L.C., K.Z., S.Y., Y.Q., Q.Y.).
Cardiology (G.H.).
AJNR Am J Neuroradiol. 2022 Mar;43(3):501-506. doi: 10.3174/ajnr.A7415. Epub 2022 Feb 3.
Percutaneous thermal ablation followed by vertebral augmentation is an emerging minimally invasive therapeutic alternative for the management of spinal metastases. This study aimed to retrospectively evaluate the effectiveness and safety of microwave ablation combined with vertebral augmentation for the treatment of painful vertebral metastases.
Overall, 91 patients with 140 metastatic vertebrae who experienced refractory moderate-to-severe pain were treated with CT-guided microwave ablation and vertebral augmentation. Procedural effectiveness was determined using the visual analog scale, daily morphine consumption, and the Oswestry Disability Index preprocedurally and during follow-up. Local tumor control was assessed at follow-up imaging.
The procedure was technically successful in all patients. The median visual analog scale score and mean morphine dose were 6 (range, 4-10) and 77.8 (SD, 31.5) mg (range, 15-143 mg), preprocedurally; 5 (range 3-8) and 34.5 (SD, 23.8) mg (range, 0-88 mg) at 3 days; 4 (range, 2-7) and 28.7 (SD, 16.4) mg (range, 0-73 mg) at 1 week; 3 (range, 1-6) and 24.6 (SD, 13.2) mg (range, 0-70 mg) at 1 month; 3 (range, 1-6) and 21.70 (SD, 10.0) mg (range, 0-42 mg) at 3 months; and 3 (range, 1-8) and 21.0 (SD, 9.9) mg (range, 0-46 mg) at 6 months postprocedurally (all < .05). A decrease in the Oswestry Disability Index score was also observed (< .01). Local control was achieved in 94.8% of the treated metastatic vertebrae during the 6-month follow-up period. Asymptomatic cement leakage occurred in 42 (30%) treated vertebrae. A grade 3 neural injury was observed in 1 patient (1.1%). The patient's neurologic function returned to normal following treatment with mannitol, glucocorticoids, and radiation therapy.
This study demonstrates that percutaneous CT-guided microwave ablation combined with vertebral augmentation is a safe and effective minimally invasive intervention for the treatment of painful spinal metastases.
经皮热消融联合椎体强化是一种新兴的微创治疗方法，用于治疗脊柱转移瘤。本研究旨在回顾性评估 CT 引导下微波消融联合椎体强化治疗疼痛性脊柱转移瘤的有效性和安全性。
共 91 例 140 个转移性椎体的患者因难治性中重度疼痛接受 CT 引导下微波消融联合椎体强化治疗。术前、随访时采用视觉模拟评分、每日吗啡消耗量和 Oswestry 功能障碍指数评估手术疗效。随访时行影像学检查评估局部肿瘤控制情况。
所有患者均成功完成手术。术前患者的视觉模拟评分中位数和平均吗啡剂量分别为 6 分（4-10 分）和 77.8mg（31.5mg）（15-143mg）；术后 3 天分别为 5 分（3-8 分）和 34.5mg（23.8mg）；术后 1 周分别为 4 分（2-7 分）和 28.7mg（16.4mg）；术后 1 个月分别为 3 分（1-6 分）和 24.6mg（13.2mg）；术后 3 个月分别为 3 分（1-6 分）和 21.70mg（10.0mg）；术后 6 个月分别为 3 分（1-8 分）和 21.0mg（9.9mg），所有差异均有统计学意义（均<.05）。Oswestry 功能障碍指数评分也有显著下降（<.01）。在 6 个月的随访期间，94.8%的治疗转移性椎体获得局部控制。42 个（30%）治疗椎体出现无症状性水泥渗漏。1 例（1.1%）患者出现 3 级神经损伤。给予甘露醇、糖皮质激素和放射治疗后，患者的神经功能恢复正常。
本研究表明，CT 引导下经皮微波消融联合椎体强化治疗疼痛性脊柱转移瘤是一种安全有效的微创介入治疗方法。
