Comparison Of Spinal Decompression Combined With Radiofrequency Ablation And Spinal Decompression Combined With Radiotherapy In The Treatment Of Spinal Metastases

Objective To compare the clinical efficacy of spinal decompression combined with Radiofrequency ablation(RFA)and Stereotactic Radiosurgery(SRS)for spinal metastasis.Methods Patients with spinal metastatic tumor who met the inclusion criteria admitted to Ningxia Medical University General Hospital from January 2010 to March 2022 were retrospectively analyzed.Both groups underwent vertebral canal decompression and vertebroplasty.Then in further treatment,16 cases were in the combined RFA group and 27 cases were in the combined SRS group.The general data and efficacy of the two groups were compared and analyzed,including gender,age,lesion site,primary tumor,operation time,intraoperative blood loss,surgical complications and clinical efficacy.Clinical efficacy was evaluated by Visual Analogue Scale(Visual Analogue Scale,VAS),Frankel Neurological function Score,Spine Instability Neoplastic Score(SINS),Karnofsky Performance Status(Karnofsky Performance Status,KPS)were followed up to evaluate the pain,neurological function and physical health status at 24 hours,1,6 and 12 months after treatment,respectively.The local control rate of tumor was calculated by WHO evaluation criteria of tumor therapeutic efficacy.Kaplan-Meier method was used to plot survival curves and record postoperative complications.Results The operative time was 2.88±0.16 h in the RFA group and 3.50±0.14 h in the SRS group,and the difference between the two groups was statistically significant(P< 0.05);The blood loss was 522.22±54.71 ml in RFA group and 817.77±46.40 ml in SRS group,and the difference between the two groups was statistically significant(P< 0.05).VAS score,Frankel nerve function score,spinal instability score and KPS function score were statistically significant between the two groups before and after surgery,pain was significantly relieved,nerve function status,spinal stability and physical life status were improved(P< 0.05);There were statistically significant differences in postoperative scores between the two groups(P<0.01),the two groups had good curative effect in relieving pain,improving nerve function,improving spinal stability and improving physical state of life.There were statistically significant differences in VAS scores at 24 h,1 month and 6 months after surgery,(P< 0.05)suggested that RFA group had more rapid analgesic advantage at 24 h,1 month and6 months after operation.In RFA group,2 patients died due to tumor progression and systemic deterioration.In SRS group,4 patients died due to tumor progression and systemic deterioration.There was no significant difference in postoperative survival between the two groups(P< 0.05).The local tumor control rates were 91.30% and 86.96% respectively 12 months after operation.Conclusion The local tumor control rate in the radiofrequency ablation group was higher than that in the stereoradiotherapy group in the near term,and the radiofrequency ablation group was superior to the stereoradiotherapy group in terms of intraoperative blood loss,operative time and rapid postoperative analgesia.There was no difference between the two methods in improving spinal stability and neurological status.