Ruan Qing Zhao, Sarrafpour Syena, Hasoon Jamal, Yong R Jason, Robinson Christopher L, Chung Matthew
Warren Alpert Medical School, Brown University, Providence, RI 02903, USA.
Department of Anesthesia and Pain Medicine, UTHealth McGovern Medical School, Houston, TX 77030, USA.
Diagnostics (Basel). 2025 Jun 9;15(12):1463. doi: 10.3390/diagnostics15121463.
: The image guidance of choice for the combination therapy of radiofrequency ablation (RFA) and vertebral augmentation (VA) in the context of vertebral disease from spinal metastases are fluoroscopy and computer tomography (CT). Here, we aimed to assess the roles of both imaging modalities and if adoption of either would influence clinical outcomes of pain, physical function, and quality of life (QoL). RFA has been favored as a minimally invasive option for managing painful spinal metastases, and it is often coupled with VA to treat underlying osseous structural instability. This combination therapy of RFA with VA, which could be performed under CT or fluoroscopy, has in recent years been recognized as highly successful for pain control and functional restoration of metastatic spine lesions. : Our scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The databases accessed were Medline and Embase, and the time frame of the search was set from database inception to 2 January 2025. The inclusion eligibility included primary research studies utilizing clearly defined imaging modalities of interest with measurable clinical end points of pain, quality of life (QoL), analgesic use, or complications. : Twenty-two articles were identified after screening fifty-eight papers using the databases. Fluoroscopy alone was the more frequently adopted imaging modality ( = 17/22, 77.3%). Almost all of the papers, regardless of the imaging modality used, consistently demonstrated reduction in pain, improvement in QoL, as well as a decrease in analgesia use. Complications were present but had minimal clinical implications, aside from a single article which appeared to demonstrate significantly higher cement leak rates with a singular case of resultant paraplegia. : Fluoroscopy- and CT-guided RFA with VA have both proven to be efficacious in reducing patient discomfort and improving functionality while keeping risks of permanent neurological injuries to a minimum.
对于脊柱转移瘤所致椎体疾病的射频消融（RFA）与椎体强化（VA）联合治疗，首选的影像引导方式是荧光透视和计算机断层扫描（CT）。在此，我们旨在评估这两种成像方式的作用，以及采用其中任何一种是否会影响疼痛、身体功能和生活质量（QoL）的临床结局。RFA作为治疗疼痛性脊柱转移瘤的微创选择而备受青睐，并且它常与VA联合用于治疗潜在的骨质结构不稳定。RFA与VA的这种联合治疗可在CT或荧光透视引导下进行，近年来已被认为在控制转移性脊柱病变的疼痛和功能恢复方面非常成功。
我们的范围综述是按照系统评价和Meta分析的首选报告项目（PRISMA）进行的。所检索的数据库为Medline和Embase，检索时间范围设定为从数据库建立到2025年1月2日。纳入标准包括使用明确界定的感兴趣成像方式且具有可测量的疼痛、生活质量（QoL）、镇痛药使用或并发症等临床终点的原发性研究。
使用数据库筛选58篇论文后，共识别出22篇文章。单独使用荧光透视是更常采用的成像方式（n = 17/22，77.3%）。几乎所有论文，无论使用何种成像方式，均一致显示疼痛减轻、QoL改善以及镇痛药使用减少。存在并发症，但除了一篇文章似乎显示骨水泥渗漏率显著更高且有一例导致截瘫的情况外，并发症的临床影响极小。
荧光透视引导和CT引导下的RFA联合VA均已证明在减轻患者不适和改善功能方面有效，同时将永久性神经损伤风险降至最低。
