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. 2026 Jun 12;146(1):216. doi: 10.1007/s00402-026-06359-4

Extravertebral temperature exposure during spinal radiofrequency ablation: an experimental surrogate assessment of neural injury risk

Annabelle Weigert 1,✉, Ralf-Thorsten Hoffmann 2, Andreas Büttner 3, Richard Zaccaria 1, Veronika Wegener 1,4, Boris Michael Holzapfel 1, Bernd Wegener 1
PMCID: PMC13263199  PMID: 42283904

Abstract

Background

Radiofrequency ablation (RFA) has become an important minimally invasive option for the treatment of painful spinal tumors and benign bone lesions. While its effectiveness within the vertebral body is well established, there is ongoing concern about unintended heat exposure of nearby neural structures. Experimental data describing how heat propagates beyond the vertebra during spinal RFA are still limited.

This experimental in vitro study aims to assess the extravertebral temperature exposure during spinal radiofrequency ablation as a surrogate parameter for potential neural injury risk under controlled conditions.

Methods

This experimental in vitro study was performed on four fresh-frozen human lumbar spines. Radiofrequency ablation was carried out using a commercially available system and standard clinical protocols. Two anatomical configurations were examined: ablation within the vertebral body and ablation within the pedicle. Temperatures were measured at predefined locations outside the vertebra, including the spinal canal and cortical boundaries, using multiple thermocouples. To aid interpretation of radiofrequency-related measurement artifacts, an additional control setup using an electrothermal heating system without radiofrequency energy was included. Temperature data were evaluated descriptively.

Results

In the control experiments, temperature profiles were consistent across all measurement sites, and no values exceeded 42 °C. During radiofrequency ablation, temperature recordings showed pronounced fluctuations related to electromagnetic interference. In the pedicle configuration, temperatures rose gradually during energy delivery and decreased after the procedure, with maximum values reaching up to 44 °C. Although temperatures above 42 °C occurred intermittently, no sustained exposure above 45 °C was observed at any extravertebral location.

Conclusions

Under controlled in vitro conditions and with intact cortical bone, spinal radiofrequency ablation led to limited heat propagation beyond the vertebral body and pedicle. Temperature levels commonly associated with irreversible neural injury were not reached or were exceeded only briefly. These findings suggest a low risk of clinically relevant thermal injury to adjacent neural structures when spinal RFA is performed with appropriate probe placement and preserved osseous integrity. Caution is warranted when applying these results to clinical situations involving cortical destruction or altered vertebral anatomy.

Keywords: Radiofrequency ablation, Spine thermal exposure, Neural safety, Extravertebral temperature, Bone metastases

Introduction

Vertebral metastases are a frequent manifestation of advanced malignant disease, with a reported prevalence of 30–50% among cancer patients [1–3]. Due to the high proportion of hematopoietic bone marrow, the spine is affected more commonly than other skeletal regions. The most frequent primary tumors include malignancies of the lung, kidney, prostate, breast and thyroid gland [4, 5]. More than half of affected patients experience significant pain caused by tumor-related bone destruction [6]. In addition, structural weakening and reduced mechanical stability of the affected vertebrae may lead to occult or overt fractures, further impairing quality of life.

Conventional treatment strategies for vertebral metastases include systemic chemotherapy, radiotherapy, surgery and pharmacological pain management through administration of potent analgesics. Surgical approaches such as posterior instrumentation for stabilization, vertebrectomy and reconstruction using cages, vertebral body replacement implants or custom-made implants are associated with substantial morbidity and prolonged recovery times and are therefore generally reserved for patients with favorable life expectancy [7, 8]. In patients with a palliative treatment strategy, minimally invasive procedures play a key role in pain control and mechanical stabilization. Vertebroplasty represents an established option and can be combined with radiofrequency ablation (RFA) to reduce tumor burden in a minimally invasive manner [8–13].

The thermal effects of radiofrequency energy on biological tissue have been known for decades and have long been used in surgical applications for cutting or coagulating small hemorrhages. More recently, thermal ablation techniques have gained importance as palliative treatment options for soft tissue and bone tumors, complementing the established curative local-ablative applications in organs such as the liver, lung and kidney, providing immediate pain relief [14–16]. In the musculoskeletal system, RFA is applied to reduce tumor tissue [17–20] and has also proven effective in the treatment of benign bone tumors, including osteoid osteoma [21–26]. Rosenthal was the first to apply this method [25, 26]. While the efficacy of thermal ablation on biological tissue has been well documented [27–29], thermal treatments inherently carry the risk of unintended heat propagation to adjacent structures [30–34]. This concern is particularly relevant in spinal RFA applications, where neural elements such as the spinal cord and nerve roots are located in close proximity to the ablation zone [12, 35, 36].

Despite increasing clinical use of spinal RFA, systematic experimental data on extravertebral temperature exposure and its potential implications for neural safety remain limited. In particular, the spatial and temporal distribution of heat outside the vertebral body during ablation has not been sufficiently characterized under controlled conditions.

The aim of this experimental in vitro study was to assess extravertebral temperature exposure during spinal radiofrequency ablation as a surrogate parameter for potential neural injury risk under controlled conditions.

Materials and methods

Specimens

Fresh frozen human spines were used for this experimental study. Specimens were obtained from the Institutes of Forensic Medicine at the Ludwig Maximilians University of Munich and at the University of Rostock. Ethical approval was granted by the University Ethics Committee of the University of Rostock (A 2012-0090). All specimens included in the study originated from recently deceased donors.

A total of four (lumbar) spines containing 20 vertebrae were included in the analysis. Specimens exhibiting severe degenerative changes such as bridging osteophytes, fissures, fractures, tumors or other structural abnormalities were excluded from the study to ensure anatomical consistency and intact cortical boundaries.

Experimental setup

To approximate physiological conditions, the specimens were placed in an 18-L water bath maintained at a constant temperature of 37 +/- 1 °C. Continuous heating of the water bath was provided by a heating plate. A magnetic stirring rod rotating at approximately 300 revolutions per minute was used to approximate convective heat dissipation related to blood flow and cerebrospinal fluid (CSF) circulation.

Temperature measurement

Temperature measurements were performed using the digital thermometer system “Testo 454” (Testo AG, Lenzkirch, Germany). Type K thermocouples (class 1) with a sensor length of 400 mm and a diameter of 0.25 mm were used. Temperature data were recorded with an accuracy of 0.01 (10− 2)° C at a sampling frequency of 0.5 Hz, resulting in approximately 800 single measurements per thermocouple over a recording period of at least 12 min per experiment.

Radiofrequency ablation procedure

Radiofrequency ablation was performed using a commercially available generator (Boston RF 3000, Boston Scientific, Marlborough, MA, USA) in combination with a “LeVeen” needle electrode. Ablations were conducted according to the manufacturer’s recommended standard protocols.

During RFA, alternating current in the frequency range of 450–500 kHz is delivered to the tissue via the active electrode, generating an oscillating electric field between the electrode and grounding pads. Ionic agitation within the tissue leads to frictional heating and localized coagulative necrosis adjacent to the electrode [37, 38]. Heat propagation beyond the immediate ablation zone occurs via conductive and convective mechanism [38]. The achieved temperature depends on applied power and exposure duration, while impedance-controlled feedback leads to termination of energy delivery once tissue coagulation limits electrical conductivity. Due to the low thermal conductivity of cortical bone, heat propagation during radiofrequency ablation of osseous tissue is partially confined within the vertebral body. This phenomenon, commonly referred to as the “oven effect,” may lead to enhanced intravertebral heat retention and a more localized ablation zone, while limiting heat dissipation toward surrounding extravertebral structures [39].

Completion of the ablation procedure was defined by an irreversible increase in tissue impedance, indicating sufficient coagulation of the target region.

Control setup to account for electromagnetic interference

During radiofrequency ablation, electromagnetic interference resulted in artifacts affecting the thermocouple readings. To enable contextual interpretation of the measured temperature profiles, a control setup using an alternative heating technology without radiofrequency-induced electromagnetic fields was implemented.

For this purpose, the Electrothermal 20 S Spine System (Smith & Nephew, Marl, Germany) was used in “Decompression mode”. Heat generation was achieved via an electrically heated catheter tip rather than a radiofrequency probe. A standardized protocol was applied, consisting of an initial temperature of 50 °C, followed by incremental increases of 1 °C every 5 s up to 90 °C, with maintenance at 90 °C for 6 min.

This control setup allowed assessment of temperature propagation under comparable spatial conditions without electromagnetic interference affecting the measurement system.

Experimental configurations

Two experimental configurations were investigated:

  1. Vertebral body configuration: Ablations were performed within the vertebral body to simulate intravertebral lesions.

  2. Pedicle configuration: Ablations were performed within the pedicle to simulate lesions in proximity to the spinal canal and neural foramina.

Thermocouple placement

In each configuration, five thermocouples were positioned at predefined anatomical locations. Placement was verified fluoroscopically.

Vertebral body configuration (Setup 1 shown in Fig. 1)

  • Probe 1: Posterior longitudinal ligament at the dorsal vertebral border within the spinal canal.

  • Probe 2: 2 mm anterior to Probe 1 within the spinal canal

  • Probe 3: Right lateral vertebral cortex.

  • Probe 4: Left lateral vertebral cortex.

  • Probe 5: Cranial endplate.

Fig. 1.

Fig. 1

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Graphical representation of the measurement setup during the treatment of a lesion inside a vertebral body. The thermocouples are placed at the rear edge of the vertebra, inside the spinal canal and at the lateral and cranial cortex

Pedicle configuration (Setup 2 shown in Fig. 2)

Fig. 2.

Fig. 2

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This figure shows the temperature profile during RFA of the control group at vertebral bodies (Electrothermal 20S Spine System” by Smith & Nephew, Marl, Germany) The probes are positioned at the same locations as in Setup 1 on the vertebrae

  • Probe 1: Medial border of the pedicle

  • Probe 2: 2 mm medial to the pedicle border within the spinal canal.

  • Probe 3: Lateral border of the pedicle.

  • Probe 4: Cranial border of the pedicle (superior neural foramen).

  • Probe 5: Caudal border of the pedicle (inferior neural foramen).

Data processing and statistical analysis

Temperature data obtained from all experiments and vertebrae were pooled and analyzed descriptively. Due to the exploratory nature of this experimental in vitro study no formal hypothesis testing was performed. Accordingly, continuous variables were not subjected to formal tests for normality but were visually inspected to assess temporal behavior and distribution characteristics.

Temperature–time curves were evaluated to identify general trends and ranges of temperature exposure. For graphical visualization only, temperature signals affected by radiofrequency-induced electromagnetic interference and transient artifacts were smoothed using a moving average filter based on 25 consecutive data points. This smoothing procedure was not applied for quantitative interpretation of absolute temperature values.

Measurements obtained at pedicle locations were additionally summarized using box-and-whisker plots to illustrate the distribution of temperature values across consecutive 30-s time intervals. Apparent outliers were interpreted in the context of radiofrequency-induced measurement artifacts and were therefore not excluded from the dataset but addressed by temporal smoothing for visualization purposes only. No missing data were present in the analyzed temperature recordings.

Data processing and graphical representation were performed using MATLAB (The MathWorks, Natick, MA, USA).

Results

Control setup

Temperature measurements obtained using the control heating system without radiofrequency-induced electromagnetic interference demonstrated homogeneous and reproducible temperature profiles across all measurement locations (Fig. 3). Following activation of the heating device, temperatures increased steadily and subsequently decreased after deactivation. Across all probes, temperatures ranged from a minimum of 36.5 °C to a maximum of 42.0 °C. No temperatures exceeding 42 °C were recorded at any measurement location.

Fig. 3.

Fig. 3

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This figure shows the temperature profile during RFA of the control group at vertebral bodies (Electrothermal 20S Spine System" by Smith & Nephew, Marl, Germany)

Vertebral body configuration (setup 1)

Temperature recordings obtained during radiofrequency ablation within the vertebral body exhibited pronounced signal fluctuations across all probes. These fluctuations affected both peak and minimum values and were temporally associated with energy delivery. For visualization purposes, temperature–time curves were therefore smoothed using a moving average Fig. 4.

Fig. 4.

Fig. 4

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The curves show the temperature profile during RFA on a Vertebra (in setup 1), the locations of the probes are: Probe 1: posterior longitudinal ligament /dorsal edge of the vertebra within the spinal canal Probe 2: 2 mm distant from the posterior border inside the spinal canal/at the cranial cortex Probe 3: On the right side of the vertebra (right lateral cortex) Probe 4: On the left side of the vertebra (left lateral cortex Probe 5: Cranial endplate of the vertebra

Analysis of the summed temperature values across all probes for each individual measurement demonstrated a characteristic pattern, with an initial increase in temperature followed by a decline toward baseline values after termination of energy delivery (Fig. 5). Peak values exceeding physiologically plausible temperature ranges were observed during energy application. In addition, temperature elevations reaching approximately 50 °C were recorded at individual time points.

Fig. 5.

Fig. 5

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All electrodes (the sum of Probe 1-5) in each measurement (Measurement 1/2/3/4/5) show, that temperature rises, and then drops again

The probes are positioned at the same locations as in Setup 1 on the vertebrae

Pedicle configuration (setup2)

In the pedicle configuration, temperature measurements showed a more uniform temporal profile compared to the vertebral body configuration (Fig. 6). Temperatures increased gradually during energy application and decreased slowly after deactivation of the device. Across all probes, measured temperatures ranged from a minimum of 37.0 °C to a maximum of 44.0 °C.

Fig. 6.

Fig. 6

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The curves show the temperature profile during RFA on a Pedicle (in setup 2): Probe 1: The medial border of the pedicle Probe 2: 2 mm distant medial border of the pedicle within the spinal canal Probe 3: Lateral border of the pedicle Probe 4: Cranial border of the pedicle (superior neural foramen) Probe 5: Caudal border of the pedicle (inferior neural foramen)

Temperatures exceeding 42 °C were intermittently observed at individual measurement locations. However, no measurements exceeded 45 °C. Boxplot analysis demonstrated a narrow temperature distribution with isolated outliers.

Discussion

In this experimental study, the risk of extravertebral temperature exposure relevant to neural structures during spinal radiofrequency ablation was assessed under controlled in vitro conditions. The measurements demonstrate that radiofrequency ablation effectively generates high temperatures at the electrode site as intended for tissue ablation, while temperature elevations recorded outside the vertebral body and pedicle remained comparatively low.

Temperature measurements obtained during radiofrequency ablation were characterized by pronounced fluctuations, particularly during energy delivery. These fluctuations are attributable to electromagnetic interference affecting the thermocouple-based measurement system, a phenomenon that has been described previously in experimental settings. As a consequence, peak temperature values recorded during radiofrequency application must be interpreted with caution, as they may not accurately reflect true tissue temperatures. To address this limitation and allow contextual interpretation of the temperature profiles, a control setup using an alternative heating technology without radiofrequency-induced electromagnetic fields was employed.

In the vertebral body configuration, temperature recordings showed marked signal variability, including peak values exceeding physiologically plausible temperature ranges. In addition to these peaks, transient temperature elevations reaching approximately 50 °C were observed. In contrast, measurements obtained in the pedicle configuration demonstrated a more uniform temporal profile. Temperatures increased gradually during energy application and decreased after deactivation of the device. Although temperatures intermittently exceeded 42 °C, no measurements above 45 °C were recorded at extravertebral locations.

The clinical relevance of these findings must be interpreted in the context of established thermal injury thresholds for neural tissue. Experimental studies have shown that prolonged exposure to temperatures of approximately 42–43 °C may lead to neurological dysfunction or histological alterations in neural tissue [34, 40, 41]. Exposure to temperatures exceeding 45 °C for extended periods has been associated with irreversible neural injury [34, 41], while temperatures in the range of 60–70 °C have been shown to cause acute loss of neural function within minutes [42]. Cosman further demonstrates that radiofrequency ablation can generate electric and thermal fields sufficient to induce irreversible tissue damage under certain conditions [42, 43]. In the present study, extravertebral temperature measurements remained below these critical thresholds or exceeded them only transiently, suggesting a limited risk of neural injury under the investigated experimental conditions.

Heat propagation during radiofrequency ablation of osseous tissue is influenced by the low thermal conductivity of cortical bone. This so-called oven effect may result in enhanced intravertebral heat retention while limiting heat dissipation toward surrounding extravertebral structures [39]. The present findings are consistent with this mechanism, as effective intravertebral heating was achieved without sustained critical temperature exposure outside the vertebra.

These results are in line with previous experimental and clinical observations. In an experimental study investigating intradiscal electrothermal therapy, intact bony and fibrous structures were shown to act as thermal barriers, thereby reducing heat propagation to adjacent tissues [30]. Similarly, Nakatsuka et al. reported that spinal canal temperatures remained below 45 °C in the majority of patients undergoing radiofrequency ablation of spinal tumors with real-time temperature monitoring [35]. These findings support the concept that careful probe placement and preservation of anatomical boundaries contribute to limiting extravertebral temperature exposure.

Several limitations of this study must be acknowledged. The experimental setup was performed in vitro and cannot fully replicate in vivo conditions, particularly with respect to physiological blood flow and cerebrospinal fluid circulation. Although convective heat dissipation was approximated using a temperature-controlled water bath with continuous circulation, this represents a simplification of the in vivo situation. Furthermore, only healthy vertebrae with intact cortical boundaries were investigated. In clinical practice, metastatic destruction of the posterior vertebral wall may facilitate increased heat propagation toward neural structures, limiting the generalizability of the present findings. In addition, the temperature measurement system was susceptible to electromagnetic interference, precluding precise determination of absolute peak temperatures during radiofrequency ablation. Importantly, the present study did not directly assess neural injury. No histological evaluation of neural tissue and no functional assessment of the spinal cord or nerve roots were performed. Accordingly, conclusions are limited to temperature-based surrogate parameters and established thermal injury thresholds reported in the literature.

Furthermore, temperature measurements were pooled and analyzed descriptively without accounting for potential dependencies between repeated measurements within the same specimen, as the study was not designed for inferential statistical comparisons but for exploratory characterization of temperature exposure patterns.

Conclusion

Radiofrequency ablation of spinal tumors/lesions relies on high intravertebral temperatures to achieve effective tissue ablation. The present experimental study demonstrates that, under controlled in vitro conditions and in the presence of intact cortical boundaries, extravertebral temperature exposure during spinal radiofrequency ablation remains below levels commonly associated with irreversible neural injury or exceeds these thresholds only transiently.

Although transient temperature elevations may occur in proximity to the ablation zone, sustained exposure to critical temperature levels outside the vertebral body was not observed. These findings suggest a limited risk of thermal injury to adjacent neural structures when radiofrequency ablation is performed with appropriate probe placement and preserved osseous integrity.

However, given the experimental nature of this study and the use of healthy vertebrae, caution is warranted when extrapolating these results to clinical situations involving extensive cortical destruction. Careful patient selection and consideration of real-time temperature monitoring remain important to further enhance procedural safety.

Author contributions

AW, RTH wrote the manuscript with support from AB, RZ, VW. RTH—carried out the experiment, wrote the manuscript, prepared figures RZ, VW- prepared the figures, BMH, BW—involved in planning, supervised the work, interpretation of the data. BW—research on current literature and supervised the findings of this work. All authors provided critical feedback, helped shape the research, analysis and manuscript, discussed the results and contributed to the final manuscript. All authors approve the submitted version of the manuscript.

Funding

This research received no external funding.

Data availability

The data presented in this study are available on request from the corresponding author.

Declarations

Conflict of interest

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

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