Interventional Oncology - Radiofrequency Ablation of Vertebral Tumours

What is Vertebral Tumour Radiofrequency Ablation?

Vertebral Tumour Radiofrequency Ablation (RFA) is a minimally invasive procedure that can be used to treat tumours of the spine (vertebra).

The spine is the most common site of skeletal metastatic disease and is also commonly affected by cancers of the bone marrow such as myeloma.  Vertebral tumours can cause crippling pain, fractures, and spinal cord compression. Radiofrequency ablation is a minimally invasive technique that has proven to be a safe method of targeted tumour destruction. Studies have shown that RFA combined with cement vertebral augmentation (vertebroplasty) is both safe and effective and is associated with significant improvements in pain and quality of life.

What tests and patient preparation are necessary before the procedure?

Prior to the procedure, all patients will have an MRI scan to confirm which vertebral bone(s) are affected and to measure the extent of disease. It is important to correlate the MRI findings with a thorough clinical examination ensuring that symptoms are attributable to the affect vertebra and not an alternative cause. If you are unable to have an MRI, a CT of the spine can be used instead.

Medications that thin the blood (antiplatelet/anticoagulant) have to be stopped at least 5 days before the procedure. It may be necessary to commence another form of temporary blood thinner for a few days if deemed clinically necessary. This will be confirmed by your doctor prior to the procedure.

How is the procedure performed?

The procedure is performed in the Interventional Radiology. The patient lies face down on an x-ray table and is given medications to reduce pain and discomfort and to make them sleepy. A dedicated nursing team will monitor and care for the patient throughout the procedure.

Following the injection of local anaesthetic into the skin and around the spine, hollow needles called introducers are passed into the vertebral body under continuous X-ray guidance. Once these needles are in place, a biopsy of the tumour can be obtained and a special radiofrequency probe is then passed down the introducer into the tumour. Radiofrequency energy is then converted to heat at the tip of the probe resulting in destruction of local tumour cells and ablation of nerves that carry pain sensations to the brain. The temperature and size of the heat zone can be controlled remotely so that the treatment is tailored to the disease of the patient.

The ablation process typically lasts for a few minutes and creates a cavity within the vertebral body. This cavity is then filled with medical grade cement which is visible on X-ray imaging. The cement mixture resembles thick toothpaste and sets hard within 20 minutes and provides strength and support to the bone and helps reduce pain and prevents future fracture/loss of height. The interventional radiologist will monitor the entire procedure on the x-ray monitors to ensure the cement fills the cavity adequately and does not leak into the spinal canal or adjacent structures.

The procedure usually takes about one hour but can take longer if more than one level is being treated.

What do patients experience after the procedure?

Bed rest is recommended for the first 3 hours following RFA and vertebroplasty, although after 1 hour patients can get up to use the bathroom if they so choose. Most outpatients go home the same day whilst inpatients usually remain in hospital whilst their pain medications are reduced according to their needs and they have physiotherapy to regain mobility.

Following discharge, patients are advised to gradually increase physical activity. Blood thinners are usually restarted on the day of the procedure.