The safety and efficacy of combined microwave ablation and percutaneous vertebral augmentation for spinal metastasis: a systematic review and meta-analysis of evidence in the last 6 years.

Abstract

PURPOSE: This study aims to evaluate the clinical safety and efficacy of combining microwave ablation (MWA) and percutaneous vertebral augmentation (PVA) for spinal metastases, as this therapeutic approach remains underexplored. METHODS: Comprehensive searches were conducted in PubMed, Europe PMC, ScienceDirect, and Google Scholar using keywords related to “microwave ablation,” “percutaneous vertebral augmentation,” and “spinal metastasis.” Eligible studies included those reporting pain scores (VAS), opioid consumption, Oswestry Disability Index (ODI), and complications. Meta-analyses performed using RevMan 5.4 and R-Studio 4.5.2. RESULTS: Thirteen studies involving 670 patients were included in this analysis. Our meta-analysis revealed improvements in postoperative scores on Day 1 (SMD − 2.46 [95% CI -3.11, -1.81], p < 0.00001), at 1 week (SMD − 3.94 [95% CI; -4.69, -3.20], p < 0.00001), at 1 month (SMD − 4.23 [95% CI; -4.95, -3.51], p < 0.00001), and at 6 months (SMD − 4.01 [95% CI; -4.73, -3.29], p < 0.00001). The Oswestry Disability Index (ODI) showed similar improvements at 1 week (SMD − 2.77 [95% CI; -3.56, -1.98], p < 0.00001), 3 months (SMD − 2.81 [95% CI; -3.51, -2.10], p < 0.00001), and 6 months (SMD − 3.50 [95% CI; -4.55, -2.45], p < 0.00001). Additionally, there was a decrease in opioid consumption at 1 week (MD -60.22 [95% CI; -77.77, -42.66], p < 0.00001), 1 month (MD -91.67 [95% CI; -114.82, -68.52], p < 0.00001), and at 6 months (MD -91.41 [95% CI; -110.47, -72.34], p < 0.00001). Most complications reported are minor complications. CONCLUSION: Microwave ablation combined with PVA effectively treats spinal metastasis, offering pain relief, improved function, and reduced opioid use.