The preliminary report of cooled microwave ablation combined with percutaneous vertebro plasty(PVP) in the treatment of spinal metastases / 中华骨科杂志

ABSTRACT

Objective To evaluate the clinical effectiveness of the treatment for spinal metastases by cooled microwave ablation combined with percutaneous vertebro plasty(PVP).Methods From February 2014 to January 2017,24 patients with spinal metastases were treated with cooled microwave ablation combined with PVP,including 14 males and 10 females with an average age of 58.2 years (range,32 to 73).Preoperatively all the patients suffered with the local pain and the spinal cord or nerve root compression symptoms.The locations of the lesions included14 in the thoracic and 10 in the lumbar.The primary tumors typelung cancer 6 cases,breast cancer 3 cases,liver cancer 2 cases,kidney cancer 2 cases,gastric cancer 1 case,prostate cancer 1 case,ovarian cancer 1 case,osteosarcoma 1 case,fibrosarcoma 1 case,colon cancer 1 case,and unknown source tumor 5 cases.The preoperative Tomita score was 4-7 points (mean 6.3 points),and the Tokuhashi score was 8-11 points (average 9.3 points).23 patients with the spinal metastatic were treated with cooled microwave ablation combined with PVP.1 patient were treated with cooled microwave ablation only.The clinical outcomes were evaluated using visual analogue scale (VAS) and Frankel grading.The local control rate was evaluated by imaging.Resuits All cases were followed up for 5 to 36 months.The tumor volume size was 3.2-12.1 cm3 by preoperative measurement.Each lesion was heated to 3-7 hot zones.Each hot zone was heated for 5 minutes.The total heating time was 15-35 minutes (mean 22.1 minutes).The temperature inside the lesion was (56.2±5.83) ℃.The temperature inside the spinal canal was (33.6±5.14) ℃.The visual analogue scale (VAS) of the 24 patients at 24 hours and 3 months after operation was statistically different from the preoperative visual analogue scale (VAS).The Frankel grading of 19 patients had at least one grade improvement 3 months after operation.6 cases died due to systemic multiple metastases 5-8 months after surgery.9 patients had more than one organ metastasis or bone metastasis during follow-up,and survived with tumors.The remaining 9 cases did not recur or transfer during the follow up period.No nerve damage or other complications were observed in all patients.Conclusion The cooled microwave ablation combined with PVP could relieve the pain in spinal metastases,relieve the nerve compression,and reconstruct the stability,which is a safe and effective palliative surgical method.