Abstract No. 51 Unipedicular versus Bipedicular Radiofrequency Ablation in Combination with Kyphoplasty for the Treatment of Painful Spine Metastases: Comparison of VAS, ECOG, Karnofsky, Oswestry Disability Index, Radiation, and Cement Volumes

To compare RF ablation in combination with kyphoplasty for the treatment of patients with painful metastatic disease to the spine, using a unipedicular or bipedicular approach. All patients with painful metastatic spinal disease who underwent kyphoplasty and RF ablation between 03/2019 and 06/2023 were reviewed in a retrospective manner. Out of 74 patients treated, 44 (59. 5%) had kyphoplasty at a single vertebra. 31 (70.5%) had RF ablation using a bipedicular access and 13 (29.5%) had unipedicular access. Mean age was 63.1 (SD:10.4), M:F ratio of 0.76. Most common primary neoplastic diseases were multiple myeloma (n=10, 22.7%), breast (n=10, 22.7%), lung (n=5, 11.4%), prostate (n=3, 6.8%). Pain relief was evaluated by the VAS and Oswestry Disability Index (ODI), performance status by the KPSS and ECOG score before and within 3-months after the procedure. The highest documented VAS, ODI, KPSS, and ECOG scores pre and post-procedure were recorded. Technical success was achieved in all patients. Kyphoplasty and RF ablation was performed on thoracic vertebrae in 20 patients (45.5%) and lumbar vertebrae in 24 patients (54.5%). The median VAS decreased from 10 (IQR, 8-10) to 3 (IQR, 0-4.75) (P < 0.001), median ODI decreased from 60.0 (IQR, 46-77.5) to 20.0 (IQR, 14.5-33.5) (p< 0.001), median KPSS increased from 50 (IQR, 40-70) to 80 (IQR, 50-90) (P =0.008), and median ECOG decreased from 3 (IQR, 2-3) to 1 (IQR, 0-2.0) within 3 months after the procedure (P = 0.001). Having a bipedicular access, patients had a higher volume of cement administered. However, the radiation exposure, pain, performance, and disability scores were not clinically and statistically different. Bipedicular access enables higher volume cement administration during kyphoplasty. However, the radiation exposure, pain, performance, and disability scores are not clinically or statistically different with either approach (Table 51.1).