Ablation and Cementation Technologies

Percutaneous management of metastatic bone disease is a rapidly evolving field. Percutaneous ablation is a commonly used modality that can be effective at achieving both pain control and local tumor control in the setting of palliative treatment of metastatic bone disease. Available ablation modalities include: cryoablation, microwave, radiofrequency, and MR-guided focused ultrasound. When percutaneous ablation is used within the bone, it is commonly combined with cement augmentation for the purpose of providing stability to the ablated structure or to areas of osteolysis. Cement augmentation is also frequently used in the absence of ablation to stabilize areas of extra-spinal osteolysis and treat cancer-related vertebral compression fractures. Observation and biomechanical studies demonstrate that extraspinal osteolytic lesions are poorly suited to cement-only stabilization. Therefore, nascent percutaneous internal fixation techniques have been developed and continue to evolve, in order to provide mechanical stability to pathologic fractures and extensive osteolytic lesion of the pelvis and sacrum, predominately.