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Percutaneous Cryoablation in the Management of Spinal Metastases: A Comprehensive Systematic Review and Meta-Analysis Publisher



Fallahi MS1, 2 ; Maroufi SF1, 3 ; Parmis Maroufi S1 ; Khorasanizadeh M4 ; De Macedo Filho LJM5 ; Margetis K6 ; Guha D7 ; Tatsui CE8 ; Mansouri A5
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Authors Affiliations
  1. 1. Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
  2. 2. Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, United States
  4. 4. Department of Neurosurgery, Medical College of Wisconson, Milwaukee, WI, United States
  5. 5. Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States
  6. 6. Icahn School of Medicine at Mount Sinai, New York, NY, United States
  7. 7. Division of Neurosurgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
  8. 8. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States

Source: Journal of Neuro-Oncology Published:2025


Abstract

Background: Minimally invasive techniques such as vertebroplasty, kyphoplasty, radiofrequency ablation, and stereotactic body radiotherapy have been widely used to manage spinal metastases. Among these, percutaneous cryoablation (PCA) has emerged as a promising option for local tumor control and pain management, offering targeted treatment with minimal damage to surrounding tissues. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of PCA for spinal metastases. Methods: A systematic review was conducted using PubMed and Embase databases to identify studies that reported outcomes of PCA for spinal metastases. The reported radiologic, clinical, and complication outcomes were then combined and analyzed using meta-analytic methods including the calculation of pooled means and proportions, subgroup analysis, and meta-regression. Results: Eleven studies, including 229 patients, met inclusion criteria and were analyzed. Patients had a mean age of 61.8 years, with 60.6% being female. Breast (18.6%), lung (16.0%), and thyroid (8.0%) were the most common primary cancer sites. PCA was primarily conducted under general anesthesia (47.5%) and with CT/MRI guidance (93.9%). Local tumor control was achieved in 70.5% of cases over a mean follow-up of 12.6 months. Pain severity significantly decreased postoperatively, with a mean reduction of 4.5 points (P < 0.0001). Major and minor complication rates were 2.0% and 4.8%, respectively. Conclusions: PCA is an effective alternative treatment for spinal metastases, offering pain relief and local tumor control with low complication rates in appropriately selected patients. However, tumor location and patient age may influence treatment outcomes, underscoring the need for individualized treatment planning. © The Author(s) 2025.
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