BACKGROUND: Pathological vertebral compression fractures exert a significant impact on cancer patients’ quality of life. Procedures that combine percutaneous vertebral augmentation with radiofrequency ablation (RFA) have expanded the therapeutic options for treating complex fractures accompanied by severe height loss and spinal compromise.

CASE REPORT: A woman in her sixties with squamous cell carcinoma of the anal canal developed a T10 metastatic burst fracture with > 80% vertebral height loss and spinal cord compression despite radiation therapy. We performed sequential RFA for local tumor control, followed by balloon kyphoplasty to create cavity space, and SpineJack® (Stryker) deployment for maximum vertebral height restoration. Complete pain relief was achieved, with significant restoration of vertebral anatomy and correction of both antero- and retropulsion. The patient remained asymptomatic at follow-up.

CONCLUSION: The use of second- and third-generation percutaneous vertebral augmentation in combination with RFA represents a promising multimodal approach for managing complex metastatic burst fractures when conventional treatments fail.

KEYWORDS: Pathological vertebral compression fracture, SpineJack®, balloon kyphoplasty, case report, radiofrequency ablation