COLD RADIOFREQUENCY ABLATION
FOR VERTEBRAL BONE TUMORS:
OSTEOCOOL, CASE REPORT AND
LITERATURE REVIEW
ABLACIÓN POR RADIOFRECUENCIA FRÍA PARA
TUMORES ÓSEOS VERTEBRALES: OSTEOCOOL,
REPORTE DE CASO Y REVISIÓN DE LA LITERATURA
Uriel Hernandez Vargas
Department of Neurosurgery of the Naval Medical Center, México
Yosselin Guadalupe De La Paz Ponce
Department of Neurosurgery of the Naval Medical Center, México
Veronica Martinez Zeron
Universidad Autonoma del Estado de Mexico
Pedro Gomez Pimentel
Universidad Nacional Autonoma de Mexico
Alexander Barker Antonio
Department of Neurosurgery of the Naval Medical Center, Mexico
Bertina Diaz de Jesus
Department of Orthopedic Oncology of the Naval Medical Center, Mexico
Juan Antonio Alvaro Heredia
Department of Neurosurgery of the Naval Medical Center, Mexico
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DOI: https://doi.org/10.37811/cl_rcm.v9i4.19904
Cold Radiofrequency Ablation for Vertebral Bone Tumors: OsteoCool,
Case Report and Literature Review
Uriel Hernandez Vargas1
urielvargas810@gmail.com
https://orcid.org/0009-0009-7525-2687
Department of Neurosurgery of the Naval
Medical Center
Mexico City
Yosselin Guadalupe De La Paz Ponce
DELAPAZYOSS@gmail.com
https://orcid.org/0009-0007-5682-5748
Department of Neurosurgery of the Naval
Medical Center
Mexico City
Veronica Martinez Zeron
dra.veronica.vmz@gmail.com
https://orcid.org/0000-0002-2621-8708
Universidad Autonoma del Estado de Mexico
Toluca, Mexico
Pedro Gomez Pimentel
drpedro.gomezp@gmail.com
https://orcid.org/0009-0006-9133-7523
Universidad Nacional Autonoma de Mexico
Mexico City
Alexander Barker Antonio
barker_ax@hotmail.com
https://orcid.org/0009-0007-6754-0924
Department of Neurosurgery of the Naval
Medical Center
Mexico City
Bertina Diaz de Jesus
dr.diazjb@hotmail.com
https://orcid.org/0009-0003-7665-5759
Department of Orthopedic Oncology of the
Naval Medical Center
Mexico City
Juan Antonio Alvaro Heredia
alvaro_go22@hotmail.es
https://orcid.org/0000-0002-4582-4738
Department of Neurosurgery of the Naval
Medical Center
Mexico City
ABSTRACT
Background: The spine is the most frequently affected site in skeletal metastases, representing up to
70% of cases. These lesions can cause severe pain, fractures, and neurological deficits, significantly
affecting quality of life. Conventional management includes opioids, bisphosphonates, surgery, and
radiotherapy; however, these may be limited by delayed recovery, toxicity, or long-term side effects.
Case presentation: We describe the case of a 38-year-old male with a vertebral lesion at T6, suggestive
of metastasis, who underwent percutaneous cold radiofrequency ablation using the OsteoCool system
combined with kyphoplasty. The procedure was completed without complications, achieving
immediate pain relief and early mobilization, allowing hospital discharge within 24 hours. Discussion:
Cold radiofrequency ablation offers a safe, minimally invasive alternative for the treatment of vertebral
bone tumors, providing rapid pain control, reduced opioid use, and early initiation of adjuvant therapies.
Conclusion: In selected patients, OsteoCool radiofrequency ablation can improve prognosis and quality
of life, representing an effective option in both palliative and curative settings.
Keywords: cold radiofrequency, bone tumors, benign tumors, metastases, spinal cord
1
Autor principal.
Correspondencia: drpedro.gomezp@gmail.com
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Ablación por Radiofrecuencia Fría para Tumores Óseos Vertebrales:
Osteocool, Reporte de Caso y Revisión de la Literatura
RESUMEN
Introducción: La columna vertebral es el sitio más frecuentemente afectado en las metástasis óseas,
representando hasta el 70% de los casos. Estas lesiones pueden provocar dolor intenso, fracturas y
déficit neurológico, con un impacto significativo en la calidad de vida. El tratamiento convencional
incluye opioides, bifosfonatos, cirugía y radioterapia; sin embargo, estas opciones pueden verse
limitadas por tiempos prolongados de recuperación, toxicidad o efectos adversos a largo plazo.
Presentación del caso: Se describe el caso de un paciente masculino de 38 años con lesión vertebral en
T6, sugestiva de metástasis, tratado mediante ablación percutánea por radiofrecuencia fría con el
sistema OsteoCool, complementada con cifoplastia. El procedimiento se realizó sin complicaciones,
logrando alivio inmediato del dolor y movilización temprana, con egreso hospitalario a las 24 horas.
Discusión: La ablación por radiofrecuencia fría constituye una alternativa segura y mínimamente
invasiva para el manejo de tumores óseos vertebrales, con control rápido del dolor, menor uso de
opioides e inicio temprano de terapias adyuvantes. Conclusión: En pacientes seleccionados, la ablación
por radiofrecuencia con OsteoCool puede mejorar el pronóstico y la calidad de vida, siendo una opción
eficaz en contextos paliativos y curativos.
Palabras clave: radiofrecuencia fría, tumores óseos, tumores benignos, metástasis, médula espinal
Artículo recibido 15 agosto 2025
Aceptado para publicación: 19 septiembre 2025
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INTRODUCTION
After the lung and liver, the skeletal system is the third most common location of metastases and one
of the most affected segments is the spine where around 70% of all bone metastases are located, and
these can be single or multiple. When this condition exists, the morbidity and quality of life of the
patients is severely affected. (1) Although they are often asymptomatic, metastases are an important
cause of morbidity and mortality and can reduce quality of life, around 80% of patients experience
intense pain before establishing the diagnosis. (2) An example of this pathology is represented by
osteoma. osteoid, which in a benign bone tumor which typically affects the long bones of the lower
limbs, can be asymptomatic or present as nocturnal pain that subsides with the ingestion of common
analgesics. (3)
Metastatic bone tumors represent 60 to 84% of cases and can manifest as pain, fracture or neurological
focalization. The goals of treatment are to make the diagnosis, decrease pain, reduce late neurological
focus, preserve function, and improve quality of life. (4) Pain associated with bone metastases may be
due to neural compression, pathological fractures, or biological mechanisms such as cytokine
production by the tumor, stimulation of nociceptors by elongation of the periosteum, or production of
nociceptors by leukocytes (5). Often the improvement in pain is not immediate, it may take 4 to 6 weeks
to be effective. The multimodal treatment approach consists of opioids, bisphosphonates, surgical
fixation and radiotherapy, however, they may be ineffective due to long recovery times after surgery,
tissue toxicity associated with radiotherapy and tolerance with increased side effects. of long-term
opioid use. (6)
Radiosurgery has demonstrated higher rates of palliation of 50 to 85%, but is associated with fracture
rates of 11 to 39%. Invasive surgical treatments such as vertebroplasty, placement of transpedicular
screws and vertebrectomy, considered invasive, help reduce pain and avoid deformation; however, they
represent a longer recovery time, a higher rate of infection and therefore greater morbidity and mortality,
and they can also delay the start of adjuvant treatments such as radiotherapy or systemic therapies.
Currently there are several types of minimally invasive treatments such as the use of analgesics such as
bisphosphonates, radiotherapy, cryotherapy and radiofrequency. (7)
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Since 2014, research protocols began for the use of new techniques in the treatment of metastatic
vertebral lesions (cold radiofrequency ablation) in animal models (8). Last 2017, a prospective study
began with the purpose of evaluating the effectiveness of Medtronic's OsteoCool radiofrequency
ablation system for reducing pain in bone metastases of thoracic and lumbar vertebrae. (9)
The OPuS One study was a prospective, multicenter, global investigation carried out to assess pain and
quality of life prior to radiofrequency ablation and its follow-up up to 12 months afterwards using the
Brief Pain Inventory (BPI) tool and the EQ index. -5 D (10), for the same purpose the European
Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C15-PAL) has also
been used. (11) Minimally invasive percutaneous radiofrequency ablation procedures have shown
improvement in pain, with prompt recovery, as well as a decrease in the use of opioids.
The objective of radiofrequency ablation is mainly improvement in pain within the first 3 days and
sustained for up to 12 months, this improvement being confirmed by assessing the worst pain,
intermediate pain and its interference with quality of life. (12) The use of radiofrequency ablation with
OsteoCool compared to performing Kyphoplasty does not show significant differences in terms of pain
reduction and the use of opioids for this purpose. (13) The OsteoCool generator produces 40 W of
power (20 W of power per channel), allowing the tip of the scope probe to maintain temperatures of 70
degrees, for a set period of time, allowing the energy to pass to the surrounding tissue and cause necrosis
due to coagulation, and the probe is capable of measuring the temperature of the surrounding tissue to
monitor critical areas such as proximity to nerve roots. (14)
MATERIALS AND METHODS
Electronic clinical record of the patient, Literature and background available in previous publications,
human and financial resources of the Naval Medical Center.
A review of the clinical case was carried out as well as the literature available in PubMed related to it.
Indications for Osteocool
Treatment of benign bone tumors where the purpose is curative, for example in osteoid osteomas, and
the second indication is the treatment of metastatic tumors, where the objective is palliative and is
limited by the size of the lesion.
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Osteocool Contraindications
Distance of less than 1 cm between the lesion and the spinal cord, lesions that affect the posterior wall
of the vertebral body, and lesions that cause cortical destruction with involvement of surrounding soft
tissue, the ones that are considered for this treatment must fulfill this conditions.
Case Presentation
38-year-old male, active duty military member of the Mexican Navy, history of being a keyboardist.
His current condition began approximately 4 months prior to his evaluation in the Neurosurgery service
when he presented sudden onset pain referred to the right scapula. He went to the emergency service
on several occasions referring pain diagnosed as mechanical lower back pain, due to the persisting pain,
he was sent to the traumatology and orthopedics service. Magnetic resonance imaging was requested,
the T2 weighted image highlighted an area of hyperintensity at the vertebral body of T6 (Figure 1), for
which he was referred to the neurosurgery service. Upon arrival, the neurological examination showed
strength 5/5 in the thoracic and pelvic limbs, corresponding chest pain at level T6 and T7, and the
perception of fine and coarse touch without abnormalities. A nuclear magnetic resonance imaging study
was evaluated, T2 sequence highlighted a space occupying lesion at T6 vertebral body and facets,
suggestive of a neoplastic lesion (Figure 2).
Taking into account the characteristics of the lesion, the patient and the procedure criteria, he was
considered as a candidate to receive a magnetic ablation system, cold radiofrequency therapy
(OsteoCool).
The procedure was explained in detail to the patient and informed consent was obtained. Prior to the
procedure, adequate ultra-short antibiotic prophylaxis was administered, after asepsis and antisepsis of
the dorsal region to be intervened, lidocaine was infiltrated with 2% epinephrine, posteriorly an
OsteoCool cannula was introduced and a second cannula was introduced. A biopsy of the lesion was
taken for histopathological examination, a second electrode was introduced for radiofrequency, number
20, with parameters of 70º Celsius and 9.0 Watts for 15 minutes without incidents (Figure 3), a cannula
for kyphoplasty was inserted with 6 cc of bone cement under fluoroscopy corroborating adequate
placement ending the procedure.
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In the recovery area the patient was asymptomatic, adequately mobilizing 4 limbs, being discharged
from the hospitalization service 24 hours after the procedure, with painless gait or any abnormalities
during the physical and neurological examination.
Figure 1. Magnetic Resonance Imaging T2 of the thoracic spine, sagittal showed an area of
hyperintensity in the vertebral body of T6 suggestive of a neoplastic process.
Figure 2. Magnetic Resonance Imaging T2 of the thoracic spine, axial showed an area of hyperintensity
in the vertebral body of T6 suggestive of a neoplastic process.
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Figure 3. Graphic record of temperature, time and radiofrequency power of the OsteoCool system,
reaching a maximum temperature of 71º Celsius and 9.8 W during the radiofrequency.
DISCUSSION
The third most common location of bone metastases corresponds to bone tissue, in turn one of the most
frequently affected sites corresponds to the spine. The cold radiofrequency ablation technique
represents one of the most innovative treatment modalities that it offers to patients. who are subjected
to it, a prompt decrease in pain, better rates of recovery and return to daily activities, as it is a new
technique, there is little information published in relation to it, in the present case the patient showed a
significant clinical improvement which agrees with previously published information, this fulfills its
primary objective, which places it as a treatment modality option for those patients who meet the criteria
to undergo radiofrequency ablation.
CONCLUSIONS
Patients with vertebral bone metastases or benign bone tumors often face significant limitations in
mobility, persistent pain, and a marked deterioration in quality of life, in addition to the high
consumption of medical, human, and economic resources required for their care. In this context, the
OsteoCool cold radiofrequency ablation system emerges as a valuable therapeutic alternative, capable
of offering rapid pain relief, minimal invasiveness, and early return to daily activities. Its ability to allow
the prompt initiation of complementary treatments, such as radiotherapy or systemic therapy, makes it
particularly advantageous in palliative settings, where every day of functional preservation counts.
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The present case illustrates not only the technical feasibility of the procedure but also its clinical benefit,
with immediate improvement in symptoms and early hospital discharge. These results are consistent
with existing literature, reinforcing the role of cold radiofrequency ablation as an effective and safe
option for carefully selected patients. Although further prospective studies with larger cohorts are
needed to establish long-term oncological outcomes, current evidence supports its inclusion as part of
the multidisciplinary management of vertebral bone lesions, whether with curative or palliative intent.
Research funding source
Naval Medical Center Resources.
Conflict of Interest
No conflict of interest to disclose.
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