Background/Objectives: Spinal metastases are a frequent and serious complication in
cancer patients, often causing severe pain, instability, and neurological deficits.
Thermal ablation techniques such as radiofrequency ablation (RFA), microwave ablation
(MWA), and cryoablation (CA) have emerged as minimally invasive treatments. These
techniques rely on precise imaging guidance to effectively target lesions while minimizing
complications. This systematic review aims to compare the efficacy of different imaging
modalities-computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy,
and mixed techniques-in guiding thermal ablation for spinal metastases, focusing on
success rates and complications. Methods: A systematic literature search was conducted
across PubMed, OVID, Google Scholar, and Web of Science databases, yielding 3733 studies.
After screening, 51 studies met the eligibility criteria. Data on success rates, tumor
recurrence, complications, and patient outcomes were extracted. Success was defined
as no procedure-related mortality, tumor recurrence or expansion, or nerve injury.
This systematic review followed PRISMA guidelines and was registered with PROSPERO
(ID: CRD42024567174). Results: CT-guided thermal ablation demonstrated high success
rates, especially with RFA (75% complete success). Although less frequently employed,
MRI guidance showed lower complication rates and improved soft-tissue contrast. Fluoroscopy-guided
procedures were effective but had a higher incidence of nerve injury and incomplete
tumor control. Mixed imaging techniques, such as CBCT-MRI fusion, showed potential
for reducing complications and improving targeting accuracy. Conclusions: CT remains
the most reliable imaging modality for guiding thermal ablation in spinal metastases,
while MRI provides enhanced safety in complex cases. Fluoroscopy, although effective
for real-time guidance, presents limitations in soft-tissue contrast. Mixed imaging
techniques like CBCT-MRI fusion offer promising solutions by combining the advantages
of both CT and MRI, warranting further exploration in future studies.
