PERCUTANEOUS ABLATIVE TECHNIQUES IN THE SURGICAL TREATMENT OF METASTATIC SPINAL TUMORS

Metastatic spinal disease represents one of the most common complications of systemic cancer, fre-quently resulting in pain, neurological deficits, and mechanical instability. Conventional treatments such as radiotherapy and open surgery are often limited in efficacy or feasibility, especially in patients with poor performance status or advanced disease. In recent years, minimally invasive percutaneous ablative techniques including radiofrequency ablation (RFA), microwave ablation (MWA), cryoabla-tion (CA), and laser interstitial thermal therapy (LITT) have emerged as valuable therapeutic options. These image-guided modalities induce targeted cytotoxic injury through thermal or cryogenic mech-anisms, enabling rapid pain palliation, local tumor control, and synergy with adjunctive procedures such as vertebral augmentation or stereotactic radiosurgery. RFA is the most established method, while MWA allows larger and more homogeneous ablation zones. CA provides the advantage of real-time visualization of the ice ball in complex anatomy, and LITT enables highly precise ablation under MRI thermometry. Although complication rates are generally low, careful patient selection, advanced imag-ing, and standardized protocols are crucial to minimize risks. Current evidence demonstrates consistent improvements in pain, mobility, and quality of life. Future directions include technological innova-tions, integration with systemic therapies, and high-quality clinical trials to define the long-term role of percutaneous ablation in spinal oncology.