Percutaneous Radiofrequency Ablation Combined With Balloon Kyphoplasty for Painful Vertebral Metastasis and Acute Pathologic Compression Fracture: A Case Report.

Painful vertebral bone metastases may result in pathologic compression fractures, severe mechanical back pain, and functional impairment. Conventional external beam radiotherapy is commonly used for palliation but is limited by delayed analgesic effects and the inability to address spinal instability. Minimally invasive image-guided techniques, such as percutaneous radiofrequency ablation (RFA) combined with vertebral cement augmentation (VCA), may provide rapid pain relief while restoring mechanical stability. We report the case of a 66-year-old man with advanced lung cancer who presented with severe opioid-refractory low back pain. Magnetic resonance imaging demonstrated an acute L4 pathologic compression fracture with approximately 40% vertebral height loss and no evidence of spinal cord compression. The patient underwent a same-session image-guided percutaneous vertebral biopsy followed by RFA and balloon kyphoplasty. Pre-procedural pain severity was assessed using the Visual Analog Scale (VAS), with a score of 10/10. Within 24 hours after the intervention, the patient reported complete pain relief (VAS 0/10) and was able to ambulate independently, without procedural complications. This case highlights same-session percutaneous RFA combined with VCA as a minimally invasive strategy capable of providing rapid pain relief and immediate spinal stabilization in selected patients with painful vertebral metastases and pathologic compression fractures without spinal cord compression.