What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis

Abstract Purpose Spinal metastases are indicative of progressive cancer which can lead to vertebral body fractures and spinal cord compression. Radiofrequency ablation (RFA) treatment is infrequently used in patients with refractory pain. The aim of this systematic review is to determine the clinica...

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Autores principales:	Navanith Murali, Thomas Turmezei, Sumbal Bhatti, Puja Patel, Thomas Marshall, Toby Smith
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Spinal metastases Radiofrequency ablation Spinal cord compression Back pain Radiotherapy Orthopedic surgery RD701-811 Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/61b7f076bc6848ad8d27900d8b753f0c
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spelling	oai:doaj.org-article:61b7f076bc6848ad8d27900d8b753f0c2021-11-08T11:01:44ZWhat is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis10.1186/s13018-021-02775-x1749-799Xhttps://doaj.org/article/61b7f076bc6848ad8d27900d8b753f0c2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13018-021-02775-xhttps://doaj.org/toc/1749-799XAbstract Purpose Spinal metastases are indicative of progressive cancer which can lead to vertebral body fractures and spinal cord compression. Radiofrequency ablation (RFA) treatment is infrequently used in patients with refractory pain. The aim of this systematic review is to determine the clinical efficacy of RFA, with the scope of using it as front-line management of spinal metastases. Methods Electronic databases were searched (to July 2020) for studies evaluating RFA treatment for spinal metastases in adults. Measured outcomes were pain (primary), disability, health-related quality of life (HRQOL), complications, tumour control and mortality. Study inclusion, data extraction and risk of bias using the ROBIN-I tool were assessed. Meta-analysis was conducted for pooled results with homogeneity, and narrative synthesis was conducted otherwise. Results 15 studies were included. RFA reduces pain scores at 3–5 weeks [standardised mean difference (SMD 2.24, 95% confidence intervals (CI) 1.55–2.93], 3–4 months (SMD 3.00, 95% CI 1.11–4.90) and 5–6 months (SMD 3.54, 95% CI 1.96–5.11). RFA is effective in reducing disability/improving HRQOL in the short-term but longer-term efficacy remains unclear. 13.2% cases reported local tumour control failure (2.5 months–5 year follow-up) whereas mortality was 23.6% (follow-up of up to 1 year). Conclusion Low quality evidence has proven RFA to be safe and effective in reducing pain and disability, especially in the short-term. RFA may be routinely implemented in all cases involving refractory pain or radiotherapy-resistant tumours but controlled trials are required to compare the efficacy of RFA to current frontline treatments. PROSPERO protocol registration number: CRD42020202377.Navanith MuraliThomas TurmezeiSumbal BhattiPuja PatelThomas MarshallToby SmithBMCarticleSpinal metastasesRadiofrequency ablationSpinal cord compressionBack painRadiotherapyOrthopedic surgeryRD701-811Diseases of the musculoskeletal systemRC925-935ENJournal of Orthopaedic Surgery and Research, Vol 16, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Spinal metastases Radiofrequency ablation Spinal cord compression Back pain Radiotherapy Orthopedic surgery RD701-811 Diseases of the musculoskeletal system RC925-935
spellingShingle	Spinal metastases Radiofrequency ablation Spinal cord compression Back pain Radiotherapy Orthopedic surgery RD701-811 Diseases of the musculoskeletal system RC925-935 Navanith Murali Thomas Turmezei Sumbal Bhatti Puja Patel Thomas Marshall Toby Smith What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis
description	Abstract Purpose Spinal metastases are indicative of progressive cancer which can lead to vertebral body fractures and spinal cord compression. Radiofrequency ablation (RFA) treatment is infrequently used in patients with refractory pain. The aim of this systematic review is to determine the clinical efficacy of RFA, with the scope of using it as front-line management of spinal metastases. Methods Electronic databases were searched (to July 2020) for studies evaluating RFA treatment for spinal metastases in adults. Measured outcomes were pain (primary), disability, health-related quality of life (HRQOL), complications, tumour control and mortality. Study inclusion, data extraction and risk of bias using the ROBIN-I tool were assessed. Meta-analysis was conducted for pooled results with homogeneity, and narrative synthesis was conducted otherwise. Results 15 studies were included. RFA reduces pain scores at 3–5 weeks [standardised mean difference (SMD 2.24, 95% confidence intervals (CI) 1.55–2.93], 3–4 months (SMD 3.00, 95% CI 1.11–4.90) and 5–6 months (SMD 3.54, 95% CI 1.96–5.11). RFA is effective in reducing disability/improving HRQOL in the short-term but longer-term efficacy remains unclear. 13.2% cases reported local tumour control failure (2.5 months–5 year follow-up) whereas mortality was 23.6% (follow-up of up to 1 year). Conclusion Low quality evidence has proven RFA to be safe and effective in reducing pain and disability, especially in the short-term. RFA may be routinely implemented in all cases involving refractory pain or radiotherapy-resistant tumours but controlled trials are required to compare the efficacy of RFA to current frontline treatments. PROSPERO protocol registration number: CRD42020202377.
format	article
author	Navanith Murali Thomas Turmezei Sumbal Bhatti Puja Patel Thomas Marshall Toby Smith
author_facet	Navanith Murali Thomas Turmezei Sumbal Bhatti Puja Patel Thomas Marshall Toby Smith
author_sort	Navanith Murali
title	What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis
title_short	What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis
title_full	What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis
title_fullStr	What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis
title_full_unstemmed	What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis
title_sort	what is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? a systematic review and meta-analysis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/61b7f076bc6848ad8d27900d8b753f0c
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What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis

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