Bone metastases often cause severe pain, skeletal instability, and neurological complications, significantly reducing the quality of life for cancer patients. Standard treatments, such as chemotherapy, radiotherapy, and bisphosphonates, may be insufficient due to their limitations. 

Minimally invasive approaches, such as microwave thermal ablation, radiofrequency ablation, alcohol injection, interstitial laser therapy, and cryoablation, offer valuable alternatives for localized disease control. Vertebral augmentation techniques, including vertebroplasty, kyphoplasty, and implants, provide spinal stabilization and pain relief.

While vertebroplasty is effective in alleviating pain associated with vertebral collapse, it has certain limitations. It does not restore the height of the vertebral body, which may lead to spinal deformities and negatively impact the overall prognosis. Additionally, because vertebroplasty does not create a controlled cavity within the vertebral body, managing cement distribution can be challenging, increasing the difficulty of preventing cement leakage. 

To refine cement placement, balloon kyphoplasty and vertebral implants have been introduced. The SpineJack® system, with expandable titanium implants, allows for controlled vertebral stabilization, height restoration, and partial reconstruction using less cement, reducing pressure on adjacent vertebrae. It is associated with a lower incidence of cement leakage and refracture compared to traditional techniques. Additionally, bone material from the drill cavity can be used for a bone biopsy during the same procedure. Originally designed for post-traumatic vertebral fractures, SpineJack® is now explored for metastatic lesions and myeloma.

SpineJack® implants can be combined with microwave thermal ablation, a technique that uses high-frequency electromagnetic waves to destroy tumor cells, achieving effective local tumor control in combination with radiotherapy and systemic therapies.

CT imaging provides detailed visualization of lytic lesions and allows precise tumor volume measurement, ensuring an effective and safe treatment. CT guidance is essential for a multiple needle placement, especially when treating also extravertebral tumor components in the same procedure.

CT also aids in positioning protective measures for surrounding structures, such as thermal protection and electrophysiologic monitoring which are crucial for safeguarding neural structures. C-arm fluoroscopy is used with CT to ensure proper placement of the SpineJack® system and real-time monitoring of implant expansion and cement placement. In our case, the C-arm is set up laterally in the CT room, being more suitable for hospitals with limited access to advanced technologies like Cone Beam CT angiography systems.