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 ....

Protocol

This study was conducted in accordance with the principles of the Declaration of Helsinki, and the study protocol was approved by the Institutional Review Board (IRB). All patients and guardians provided written informed consent. Inclusion criteria: (1) Thoracolumbar metastatic tumor confirmed by preoperative imaging and puncture biopsy; (2) ESCC classification of spinal cord compression greater than 1a; (3) Expected survival time of the patients ≥3 months as assessed by the modified Tokuhashi score and Tomita scor.......

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.......

Materials

Name	Company	Catalog Number	Comments
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