CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture

Objective

To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous screw fixation plus cementoplasty (PSFPC), for either treatment of painful metastatic fractures or prevention of pathological fractures, in patients who are not candidates for surgical stabilization.

Materials and methods

Twenty-seven patients with 34 metastatic bone lesions underwent CT-guided PSFPC. Bone metastases were located in the vertebral column, femur, and pelvis. The primary end point was the evaluation of feasibility and complications of the procedure, in addition to the length of hospital stay. Pain severity was estimated before treatment and 1 and 6 months after the procedure using the visual analog scale (VAS). Functional outcome was assessed by improved patient walking ability.

Results

All sessions were completed and well tolerated. There were no complications related to either incorrect positioning of the screws during bone fixation or leakage of cement. All patients were able to walk within 6 h after the procedure and the average length of hospital stay was 2 days. The mean VAS score decreased from 7.1 (range, 4–9) before treatment to 1.6 (range, 0–6), 1 month after treatment, and to 1.4 (range 0–6) 6 months after treatment. Neither loosening of the screws nor additional bone fractures occurred during a median follow-up of 6 months.

Conclusions

Our results suggest that PSFPC might be a safe and effective procedure that allows the stabilization of the fracture and the prevention of pathological fractures with significant pain relief and good recovery of walking ability, although further studies are required to confirm this preliminary experience.

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Author informationAuthors and Affiliations

Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital “A. Businco”, Regional Referral Center for Oncologic Diseases, Cagliari, 09100, Italy

Claudio Pusceddu, Nicola Ballicu, Rosa Maria Fele, Barbara Sotgia & Luca Melis

Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy

Alessandro Fancellu

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Rosa Maria FeleView author publications

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Correspondence to Claudio Pusceddu.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Pusceddu, C., Fancellu, A., Ballicu, N. et al. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol 46, 539–545 (2017). https://doi.org/10.1007/s00256-017-2584-y

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Received: 17 June 2016

Revised: 17 January 2017

Accepted: 20 January 2017

Published: 13 February 2017

Issue Date: April 2017

DOI: https://doi.org/10.1007/s00256-017-2584-y