Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: The spine is a common area of metastasis to the bone. Radiation therapy has been the standard treatment for focal metastatic spine tumors, and although it has shown an ability to reduce pain, it is not curative for all patients and can negatively impact a patient’s quality of life. Treating spinal metastatic pain with the use of radiofrequency ablation (RFA) in combination with kyphoplasty has been shown to be safe and effective in the treatment of spinal metastatic pain. We present a case of using balloon kyphoplasty with OsteoCoolTM RFA for treating both spinal metastasis and pain.
CASE REPORT: A 65-year-old man with a history of prostate cancer presented with metastasis to the L1 vertebral body and chronic low back pain refractory to multimodal pharmacologic treatment. He previously had radiation therapy for this bone metastasis and was maintained on enzalutamide for prostate cancer with decreasing prostate-specific antigens followed by hematology/oncology. Balloon kyphoplasty with OsteoCool RFA was performed with resolution of the patient’s pain as well as the tumor metastasis.
CONCLUSION: To our knowledge, there is no available literature discussing the administration of all the above (i.e., RFA, kyphoplasty/vertebroplasty, radiation) together, the sequence in which they are performed, the benefits and consequences of the treatment sequence, the time to and level of pain relief, and differences in radiation exposure. The results of this case provide a clinical rationale for performing RFA and kyphoplasty prior to radiation treatment, while further studies should be conducted to further elucidate the best administration of this treatment.
KEY WORDS: Back pain, bone, cancer, kyphoplasty, metastasis, radiation, radiofrequency ablation, vertebroplasty