{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:21:42Z","timestamp":1760059302486,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The image guidance of choice for the combination therapy of radiofrequency ablation (RFA) and vertebral augmentation (VA) in the context of vertebral disease from spinal metastases are fluoroscopy and computer tomography (CT). Here, we aimed to assess the roles of both imaging modalities and if adoption of either would influence clinical outcomes of pain, physical function, and quality of life (QoL). RFA has been favored as a minimally invasive option for managing painful spinal metastases, and it is often coupled with VA to treat underlying osseous structural instability. This combination therapy of RFA with VA, which could be performed under CT or fluoroscopy, has in recent years been recognized as highly successful for pain control and functional restoration of metastatic spine lesions. Methods: Our scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The databases accessed were Medline and Embase, and the time frame of the search was set from database inception to 2 January 2025. The inclusion eligibility included primary research studies utilizing clearly defined imaging modalities of interest with measurable clinical end points of pain, quality of life (QoL), analgesic use, or complications. Results: Twenty-two articles were identified after screening fifty-eight papers using the databases. Fluoroscopy alone was the more frequently adopted imaging modality (n = 17\/22, 77.3%). Almost all of the papers, regardless of the imaging modality used, consistently demonstrated reduction in pain, improvement in QoL, as well as a decrease in analgesia use. Complications were present but had minimal clinical implications, aside from a single article which appeared to demonstrate significantly higher cement leak rates with a singular case of resultant paraplegia. Conclusions: Fluoroscopy- and CT-guided RFA with VA have both proven to be efficacious in reducing patient discomfort and improving functionality while keeping risks of permanent neurological injuries to a minimum.<\/jats:p>","DOI":"10.3390\/diagnostics15121463","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T04:23:02Z","timestamp":1749442982000},"page":"1463","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Clinical Outcomes Between Fluoroscopic and Computer Tomographic Guidance in Concurrent Use of Radiofrequency Ablation and Vertebral Augmentation in Spinal Metastases: A Scoping Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Qing Zhao","family":"Ruan","sequence":"first","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syena","family":"Sarrafpour","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School, Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8227-1864","authenticated-orcid":false,"given":"Jamal","family":"Hasoon","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, UTHealth McGovern Medical School, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6960-9621","authenticated-orcid":false,"given":"R. Jason","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women\u2019s Hospital, 75 Francis St, Boston, MA 02118, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6276-9056","authenticated-orcid":false,"given":"Christopher L.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women\u2019s Hospital, 75 Francis St, Boston, MA 02118, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Division of Anesthesia, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0304-3959(99)00006-8","article-title":"Breakthrough pain: Characteristics and impact in patients with cancer pain","volume":"81","author":"Portenoy","year":"1999","journal-title":"Pain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1156618","DOI":"10.3389\/fonc.2023.1156618","article-title":"Management of pain in patients with bone metastases","volume":"13","author":"Jing","year":"2023","journal-title":"Front. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ejca.2018.08.028","article-title":"Clinical management of spinal metastases\u2014The Dutch national guideline","volume":"104","author":"Bollen","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Colonna, S., Bianconi, A., Cofano, F., Prior, A., Di Perna, G., Palmieri, G., Zona, G., Garbossa, D., and Fiaschi, P. (2023). Radiofrequency Ablation in Vertebral Body Metastasis with and without Percutaneous Cement Augmentation: A Systematic Review Addressing the Need for SPINE Stability Evaluation. Diagnostics, 13.","DOI":"10.3390\/diagnostics13061164"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S1470-2045(21)00196-0","article-title":"Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: An open-label, multicentre, randomised, controlled, phase 2\/3 trial","volume":"22","author":"Sahgal","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.semradonc.2022.11.006","article-title":"Stereotactic Body Radiation Therapy for Spinal Metastases: Benefits and Limitations","volume":"33","author":"Guckenberger","year":"2023","journal-title":"Semin. Radiat. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"20190211","DOI":"10.1259\/bjr.20190211","article-title":"Spinal metastasis: Diagnosis, management and follow-up","volume":"92","author":"Gerszten","year":"2019","journal-title":"Br. J. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1634\/theoncologist.2012-0293","article-title":"The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors","volume":"18","author":"Laufer","year":"2013","journal-title":"Oncologist"},{"key":"ref_9","unstructured":"Wray, J.K., Dixon, B., and Przkora, R. (2024). Radiofrequency Ablation, StatPearls Publishing LLC."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"759","DOI":"10.3174\/ajnr.A4595","article-title":"Radiographic Local Control of Spinal Metastases with Percutaneous Radiofrequency Ablation and Vertebral Augmentation","volume":"37","author":"Wallace","year":"2016","journal-title":"Am. J. Neuroradiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"818760","DOI":"10.3389\/fonc.2021.818760","article-title":"Management of Spinal Bone Metastases with Radiofrequency Ablation, Vertebral Reinforcement and Transpedicular Fixation: A Retrospective Single-Center Case Series","volume":"11","author":"Giammalva","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1136\/jnis.2010.002675","article-title":"Palliation of compression fractures in cancer patients by vertebral augmentation: A retrospective analysis","volume":"2","author":"Jha","year":"2010","journal-title":"J. Neurointerv. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1136\/jnis.2010.002394","article-title":"Practical management of malignant compression fractures","volume":"2","author":"Hirsch","year":"2010","journal-title":"J. Neurointerv. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"30","DOI":"10.21037\/aoj-20-103","article-title":"A narrative review of the application of radiofrequency ablation in the surgery of spinal metastases","volume":"6","author":"Lu","year":"2021","journal-title":"Ann. Jt."},{"key":"ref_15","unstructured":"Patel, A., Petrone, B., and Carter, K.R. (2024). Percutaneous Vertebroplasty and Kyphoplasty, StatPearls Publishing LLC."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"573","DOI":"10.36076\/ppj.2015\/18\/573","article-title":"Combined Ablation and Radiation Therapy of Spinal Metastases: A Novel Multimodality Treatment Approach","volume":"18","author":"Greenwood","year":"2015","journal-title":"Pain Physician"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1016\/j.jvir.2020.07.014","article-title":"Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients","volume":"31","author":"Levy","year":"2020","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/s00270-023-03417-x","article-title":"Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Study","volume":"46","author":"Levy","year":"2023","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4257","DOI":"10.3390\/curroncol30040324","article-title":"Clinical Rationale of Using Steerable Technologies for Radiofrequency Ablation Followed by Cavity Creation and Cement Augmentation in the Treatment of Painful Spinal Metastases","volume":"30","author":"Pusceddu","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e500","DOI":"10.1016\/j.wneu.2022.02.052","article-title":"The Addition of Radiofrequency Tumor Ablation to Kyphoplasty May Reduce the Rate of Local Recurrence in Spinal Metastases Secondary to Breast Cancer","volume":"161","author":"Ragheb","year":"2022","journal-title":"World Neurosurg"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E441","DOI":"10.36076\/ppj\/2019.22.E441","article-title":"Spinal Radiofrequency Ablation Combined with Cement Augmentation for Painful Spinal Vertebral Metastasis: A Single-Center Prospective Study","volume":"22","author":"Sayed","year":"2019","journal-title":"Pain Physician"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2874","DOI":"10.1007\/s00586-021-06858-5","article-title":"Radiofrequency ablation and balloon kyphoplasty for palliation of painful spinal metastases","volume":"30","author":"Ezzati","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.3174\/ajnr.A1548","article-title":"Bone cement deposition patterns with plasma-mediated radio-frequency ablation and cement augmentation for advanced metastatic spine lesions","volume":"30","author":"Georgy","year":"2009","journal-title":"Am. J. Neuroradiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2147\/JPR.S122211","article-title":"Percutaneous vertebroplasty and interventional tumor removal for malignant vertebral compression fractures and\/or spinal metastatic tumor with epidural involvement: A prospective pilot study","volume":"10","author":"Gu","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1007\/s00256-020-03473-1","article-title":"Comparison of post-operative pain scores and opioid use between kyphoplasty and radiofrequency ablation (RFA) systems combined with cement augmentation","volume":"49","author":"Jain","year":"2020","journal-title":"Skelet. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1186\/s12883-020-01998-5","article-title":"Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases","volume":"20","author":"Lv","year":"2020","journal-title":"BMC Neurol."},{"key":"ref_27","first-page":"3129","article-title":"Radiofrequency Heat Ablation and Vertebroplasty in the treatment of neoplastic vertebral body fractures","volume":"24","author":"Masala","year":"2004","journal-title":"Anticancer Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.jvir.2009.03.035","article-title":"Combined Cementoplasty and Radiofrequency Ablation in the Treatment of Painful Neoplastic Lesions of Bone","volume":"20","author":"Munk","year":"2009","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e420","DOI":"10.1016\/j.wneu.2022.03.140","article-title":"Radiofrequency Ablation and Augmentation in the Management of Spinal Metastases: Clinical Experience in 41 Patients","volume":"163","author":"Senol","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/neurintsurg-2016-012908","article-title":"Multicenter clinical and imaging evaluation of targeted radiofrequency ablation (t-RFA) and cement augmentation of neoplastic vertebral lesions","volume":"10","author":"Reyes","year":"2018","journal-title":"J. Neurointerv. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s11547-009-0431-5","article-title":"Combined radiofrequency and kyphoplasty in painful osteolytic metastases to vertebral bodies","volume":"115","author":"Sandri","year":"2010","journal-title":"Radiol. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.3174\/ajnr.A5752","article-title":"Simultaneous bipedicular radiofrequency ablation combined with vertebral augmentation for local tumor control of spinal metastases","volume":"39","author":"Tomasian","year":"2018","journal-title":"Am. J. Neuroradiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1186\/s12891-021-04799-0","article-title":"Role of radiofrequency ablation and cement injection for pain control in patients with spinal metastasis","volume":"22","author":"Yildizhan","year":"2021","journal-title":"BMC Musculoskelet Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"556","DOI":"10.12659\/MSM.889742","article-title":"A preliminary study of the safety and efficacy of radiofrequency ablation with percutaneous kyphoplasty for thoracolumbar vertebral metastatic tumor treatment","volume":"20","author":"Zheng","year":"2014","journal-title":"Med. Sci. Monit."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1129658","DOI":"10.3389\/fonc.2023.1129658","article-title":"Risk factors for pulmonary cement embolism after percutaneous vertebroplasty and radiofrequency ablation for spinal metastases","volume":"13","author":"Wang","year":"2023","journal-title":"Front. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s00256-021-03788-7","article-title":"The combination of radiofrequency ablation and vertebroplasty shows advantages over single vertebroplasty in treating vertebral neoplastic lesions","volume":"51","author":"Wang","year":"2022","journal-title":"Skelet. Radiol."},{"key":"ref_37","first-page":"2787","article-title":"Prospective Pilot-study of Combined Bipolar Radiofrequency Ablation and Application of Bone Cement in Bone Metastases","volume":"29","author":"Proschek","year":"2009","journal-title":"Anticancer Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1007\/s00256-016-2404-9","article-title":"Radiofrequency ablation alone or in combination with cementoplasty for local control and pain palliation of sacral metastases: Preliminary results in 11 patients","volume":"45","author":"Madaelil","year":"2016","journal-title":"Skeletal Radiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1093\/jjco\/hyy090","article-title":"Palliative pain relief and safety of percutaneous radiofrequency ablation combined with cement injection for bone metastasis","volume":"48","author":"Zhao","year":"2018","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Kastler, A., Barb\u00e9, D.A., Alemann, G., Hadjidekov, G., Cornelis, F.H., and Kastler, B. (2021). Bipolar radiofrequency ablation of painful spinal bone metastases performed under local anesthesia: Feasibility regarding patient\u2019s experience and pain outcome. Medicina, 57.","DOI":"10.3390\/medicina57090966"},{"key":"ref_41","first-page":"100317","article-title":"Combination radiofrequency ablation and vertebral cement augmentation for spinal metastatic tumors: A systematic review and meta-analysis of safety and treatment outcomes","volume":"17","author":"Chen","year":"2024","journal-title":"N. Am. Spine Soc. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/pm\/pnw116","article-title":"Thermocoagulation of the Medial Branch of the Dorsal Branch of the Lumbal Spinal Nerve: Flouroscopy Versus CT","volume":"18","author":"Feigl","year":"2017","journal-title":"Pain Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1016\/j.spinee.2020.03.015","article-title":"The clinical utility of fluoroscopic versus CT guided percutaneous transpedicular core needle biopsy for spinal infections and tumours: A randomized trial","volume":"20","author":"Lee","year":"2020","journal-title":"Spine J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1007\/s00256-008-0585-6","article-title":"Combined CT and fluoroscopic guidance of balloon kyphoplasty versus fluoroscopy-only procedures","volume":"38","author":"Amoretti","year":"2009","journal-title":"Skelet. Radiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1007\/s00256-021-03920-7","article-title":"Radiation dose of fluoroscopy-guided versus ultralow-dose CT-fluoroscopy-guided lumbar spine epidural steroid injections","volume":"51","author":"Wieschhoff","year":"2022","journal-title":"Skelet. Radiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.clinimag.2022.02.013","article-title":"Augmented reality overlay fluoroscopic guidance versus CT-fluoroscopic guidance for sacroplasty","volume":"85","author":"Sag","year":"2022","journal-title":"Clin. Imaging"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1463\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:48:41Z","timestamp":1760032121000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,9]]},"references-count":46,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["diagnostics15121463"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15121463","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,6,9]]}}}