(29) "No-Option” Malignant Vertebra Plana: Technical Pearls and Updated Outcomes After Salvage RFA + Kyphoplasty

Alan Sag, MD – Assistant Professor, Interventional Radiology and Orthopaedic Surgery, Duke University Medical Center

Purpose: There is an unmet need for citable studies dedicated to surgically-ineligible cancer patients with pathologic vertebra plana, especially after exhausting radiotherapy. Plana geometry is perceived as a relative contraindication to RF Ablation + Kyphoplasty; Tumor board hesitancy may lead to patients not receiving this care despite procedural inclusion in the NCCN Adult Cancer Pain Guidelines. The authors aim to present these outcomes as well as pearls for the workup and technical approach to plana geometry.

Material and Methods: IRB-approved retrospective review of all patients that underwent both vertebral augmentation and RF ablation. Patient charts were reviews to determine clinical outcome following augmentation and technical success. Plana was determined on pre-procedural imaging and latest available follow-up imaging was reviewed to determine subsequent fractures.

Results: Between 2019 and 2022, 7 patients with pathologic vertebra plana were treated (Average age 64 years, 29% myeloma (2/7), 100% female, 43% known osteoporosis (3/7), 43% radiotherapy to same level before/after kyphoplasty (3/7), 57% within the T spine (4/7). Post-kyphoplasty pain relief (partial or complete) was reported at the first post augmentation clinic visits in 5/7 patients (71%). There were 2 patients who had multiple treated levels. At latest available imaging follow-up (average 314 days post-kyphoplasty, range 8-700 days) adjacent level fractures were seen in 1 patient. Discal cement extrusion was evident in 2/7 patients (29%). There was cement seen in the anterior venous plexus in 2/7 (29%) of patient. No patients required decompressive laminectomy. A single patient had cement extravasation into the anterior paraspinal soft tissue.

Conclusions: With no serious complications in this series, RF Ablation + Kyphoplasty reduced pain in 71% of patients with pathologic vertebra plana and should be considered in the salvage palliative IR setting. Plana-specific workup and technical pearls are presented.