MRI-guided cryoablation for metastatic spine disease: intermediate-term clinical outcomes in 14 consecutive patients

OBJECTIVE Minimal access ablative techniques have emerged as a less invasive option for spinal metastatic disease reduction and separation from neural tissue. Compared with heat-based ablation modalities, percutaneous image-guided cryoablation allows for more distinct visualization of treatment margins. The authors report on a series of patients undergoing MRI-guided cryoablation as a feasible method for treating spinal metastatic disease. METHODS A total of 14 patients with metastatic spine disease undergoing MR-monitored cryoablation were prospectively enrolled. Procedures were performed in an advanced imaging operating suite with the use of both CT and MRI to gain access to the spinal canal and monitor real-time cryoablation. RESULTS The average age was 54.5 years (range 35-81 years). The mean preoperative Karnofsky Performance Status score was 79.3 (range 35-90). The average radiographic follow-up was 7.1 months (range 25-772 days), and the average clinical follow-up was 9.8 months (range 7-943 days). In 10 patients with epidural disease, 7 patients underwent postprocedural imaging, and of these 71% (5/7) had stable or reduced radiographic disease burden. Bone regrowth was observed in 63% (5/8) of patients with bone ablation during the treatment who had postoperative imaging. Pre- and postoperative visual analog scale scores were obtained, and a significant reduction in these scores was found following ablation. There were no complications. CONCLUSIONS MR-guided cryoablation is a minimally invasive treatment option for metastatic spine disease. In patients with epidural disease, the majority experienced tumor reduction or arrest at follow-up. In addition, pain was significantly improved following ablation. The average hospital stay was short, and the procedure was safe in a range of patients who are otherwise not ideal candidates for standard treatment.