Microsurgical Decompression and Targeted Radiofrequency Ablation and Radiofrequency Sacrum-Kyphoplasty Combined As Palliative Treatment for Sacrum Metastases

Metastases of the spine are common reasons for back pain in patients with advanced tumor stages of different cancers. Palliative treatment in these patients aims at reducing pain for a better quality of life. Procedures with radiofrequency ablation and cement augmentation of the lesion have shown good results. In patients with infiltration of the spinal canal further microsurgical techniques are required. We report of a 81-years old man with metastases of left sacrum with back pain and S1-radiculopathy due to infiltration of the spinal canal with compression of the S1-nerve root. The patient underwent microsurgical decompression L5/S1 left with decompression of the S1-nerve root followed by radiofrequency ablation and vertebral cement augmentation of the left sacrum. Surgery was performed without complications. The patient recovered quickly and pain was reduced from VAS 8-9 before surgery to VAS 1 one day after surgery and remained still at VAS 1 four months after surgery. Further radiation and chemotherapy were planned. Pain due sacrum metastases can be treated effectively by radiofrequency ablation and vertebral augmentation. In cases of infiltration of the spinal canal a microsurgical decompression of the nerval strutures can be combined.