Clinical benefits of CT-guided microwave ablation combined with percutaneous vertebroplasty for spinal metastases: Local tumor control and a multivariate analysis of bone cement leakage  期刊论文  

Background and Purpose CT-Guided Microwave Ablation Combined with Percutaneous Vertebroplasty for Spinal Metastases is an emerging minimally invasive therapeutic option. This study aimed to compare the clinical efficacy and risk factors for bone cement leakage in CT-guided percutaneous vertebroplasty (PVP) with or without microwave ablation (MWA) in the treatment of spinal metastases. Materials and Methods A retrospective analysis was conducted on 69 patients with 104 vertebral metastases treated between January 2019 and December 2022, divided into two groups: PVP group(n = 23, 37 vertebrae) underwent PVP alone, and MWA + PVP group(n = 46, 67 vertebrae) underwent MWA combined with PVP. Postoperative pain, daily living capabilities, and other parameters were compared, and CT and MRI were used to assess bone cement leakage and tumor control. Logistic regression analysis was used to evaluate the risk factors for leakage. Results The technical success rate was 100 % for both groups.The Visual Analog Scale(VAS), Daily Morphine Consumption(DMC), Oswestry Disability Index(ODI), and Activity of Daily Living Scale(ADL) scores at various postoperative time points in both the PVP and MWA + PVP groups showed significant improvements compared to preoperative levels (P < 0.05). However, there were no significant differences between the two groups within 12 weeks (P > 0.05), but at the 24-week follow-up, the MWA + PVP group exhibited superior scores (P < 0.05).At the 24-week postoperative follow-up, the local tumor control rates for patients and lesions in the PVP group were 78.26 % (18/23) and 78.38 % (29/37), respectively, while those in the MWA + PVP group were 91.30 % (42/46) and 91.04 % (61/67), respectively. PVP group had mild bone cement leakage in 64.80 % of vertebrae, compared to 22.30 % in MWA + PVP group. Multifactorial logistic analysis revealed that microwave ablation is an independent protective factor against bone cement leakage, cortical bone cement leakage, and vascular bone cement leakage, with an approximately consistent odds ratio (OR) of 0.2 for its protective effect, and these associations were statistically significant (P-values of 0.008, 0.005, and 0.007, respectively).Conversely, Pathological fractures (OR = 29.6,P < 0.001)and posterior vertebral wall ruptures(OR = 17.3,P = 0.01) were two independent risk factors for bone cement leakage, and the volume of bone cement injected was an independent risk factor for spinal canal bone cement leakage (OR = 1.7, P = 0.01). Conclusion Compared with PVP alone, MWA combined with PVP in the treatment of spinal metastases not only demonstrates more pronounced tumor control efficacy but also effectively reduces the risk of bone cement leakage. This finding offers a novel perspective for the minimally invasive treatment of spinal metastases and provides robust clinical evidence for optimizing treatment regimens and enhancing patients'' quality of life. It holds promise as one of the significant options in the therapeutic arsenal against spinal metastases.