Clinical efficacy and safety of robot-assisted targeted co-ablation combined with vertebroplasty under local anesthesia for spinal metastases.

Purpose: To evaluate the clinical efficacy and safety of robot-assisted targeted co-ablation (CA) combined with percutaneous vertebroplasty (PVP) under local anesthesia for spinal metastases.

Methods: This was a retrospective study of 43 patients with spinal metastases treated in our hospital from October 2022 to October 2023. Among the 43 patients, 18 underwent robot-assisted targeted CA combined with PVP (CA group) and 25 underwent PVP alone (PVP group). The visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Karnofsky Performance Status (KPS) were used to evaluate the intensity of pain, and the quality of life.

Results: There were no significant differences in the baseline data between the two groups (P > 0.05). The time of puncture channel establishment in the CA group was significantly shorter than that in the PVP group (11.33 ± 2.22 vs. 26.72 ± 4.20 min, P < 0.001). There were significantly improvements in VAS, ODI and KPS of two groups at each follow-up visit than before the operation (P > 0.05). However, at the 6 months follow-up, patients of the CA group had significantly lower VAS and ODI scores than the PVP group, and the KPS was higher (P < 0.05). The imaging examination performed at 6 months after the operation revealed that only one patient (5.6%) in CA group experienced local tumor progression (LTP), whereas 9 patients (36%) in PVP group, and the difference was significant (P = 0.03). The incidence of cement leakage in CA group (11.1%) was significantly lower than that in PVP group (44%) (P = 0.02). Multivariate logistic regression analysis of independent risk factors against LTP confirmed that a maximum diameter of spinal metastases ≥ 3.0 cm is an independent risk factor (OR: 7.413, P = 0.022). While, robot-assisted targeted CA combined with PVP is an independent protective factor (OR: 0.095, P = 0.045). For cement leakage, robot-assisted CA combined with PVP was also the independent protective factor (OR: 0.159, P = 0.031).

Conclusions: Robot-assisted targeted CA combined with PVP under local anesthesia can provide durable pain relief and improve the quality of life of patients.