Percutaneous Cryoablation in the Treatment of Spinal Metastases: A Systematic Review and Meta-analysis

Introduction: Spinal metastases are a significant cause of morbidity in cancer patients. Minimally invasive techniques such as vertebroplasty, kyphoplasty, radiofrequency ablation, and stereotactic body radiotherapy have been widely used to manage these metastases. Among these, percutaneous cryoablation (PCA) has emerged as a promising option for local tumor control and pain management, offering targeted treatment with minimal damage to surrounding tissues. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of PCA for spinal metastases.

Methods: A systematic review was conducted using PubMed and Embase databases to identify studies that reported outcomes of PCA for spinal metastases. The reported radiologic, clinical, and complication outcomes were then combined and analyzed using meta-analytic methods including the calculation of pooled means and proportions, subgroup analysis, and meta-regression.

Results: Eleven studies, including 229 patients, met inclusion criteria and were analyzed. Ten studies were retrospective, and one was prospective, with participants primarily from the United States (N= 4), France, Italy, and Switzerland. Patients had a mean age of 61.8 years, with 60.6% being female. Breast (18.6%), lung (16.0%), and thyroid (8.0%) were the most common primary cancer sites. PCA was primarily conducted under general anesthesia (47.5%) and with CT/MRI guidance (93.9%). Local tumor control was achieved in 70.5% of cases over a mean follow-up of 12.6 months. Pain severity (Visual analog scale and Numerical rating scale) significantly decreased postoperatively, with a mean reduction of 4.5 points (P < 0.0001). Major and minor complication rates were 2.0% and 4.8%, respectively.

Conclusion : PCA is an effective alternative treatment for spinal metastases, offering pain relief and local tumor control with low complication rates in appropriately selected patients. However, tumor location and patient age may influence treatment outcomes, underscoring the need for individualized treatment planning.