Percutaneous osteosynthesis in the pelvis in cancer patients

Deschamps F; DeBaere T; Hakime A; Pearson E; Farouil G; et al.

Percutaneous osteosynthesis in the pelvis in cancer patients

Author(s): Deschamps F, DeBaere T, Hakime A, Pearson E, Farouil G, et al.

Abstract

Purpose

Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists. We report our experience in cancer patients.

Material/methods

We retrospectively reviewed all cases of percutaneous osteosynthesis (PO) of the pelvic ring and proximal femur performed in our hospital. PO were performed for fracture palliation or for osteolytic metastases consolidation. Screws were inserted under CT- or cone-beam CT- guidance and general anaesthesia. Patients were followed-up with pelvic-CT and medical consultation at 1 month, then every 3 months. For fractures, the goal was pain palliation and for osteolytic metastases, pathologic fracture prevention.

Results

Between February 2010 and August 2014, 64 cancer patients were treated with PO. Twenty-one patients had PO alone for 33 painful fractures (13 bone-insufficiency, 20 pathologic fractures). The pain was significantly improved at 1 month (VAS score = 20/100 vs. 80/100). In addition, 43 cancer patients were preventively consolidated using PO plus cementoplasty for 45 impending pathologic fractures (10 iliac crests, 35 proximal femurs). For the iliac crests, no fracture occurred (median-FU = 75 days). For the proximal femurs, 2 pathological fractures occurred (fracture rate = 5.7 %, median-FU = 205 days).

Conclusion

PO is a new tool in the therapeutic arsenal of interventional radiologists for bone pain management.

Key Points

• Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists.

• CT- or CBCT-guidance results in high technical success rates for screw placement.

• This minimally invasive technique avoids extensive surgical exposure in bone cancer patients.

• Osteosynthesis provides pain relief for bone-insufficiency fractures and for pathologic fractures.

• Osteosynthesis plus cementoplasty provide prophylactic consolidation of impending pathological fractures.

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Acknowledgments

The authors thank Lorna Saint-Ange for editing this manuscript.

The scientific guarantor of this publication is Pr Thierry de Baere. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. The first 12 patients of this series have been previously reported in a published paper: "Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur. Deschamps F, Farouil G, Hakime A, Teriitehau C, Barah A, de Baere T. Cardiovasc Intervent Radiol. 2011 Dec 28"

Methodology: retrospective, observational/performed at one institution.

Author informationAuthors and Affiliations

Interventional Radiology Department, Gustave Roussy, Villejuif, F-94805, France

Frederic Deschamps, Thierry de Baere, Antoine Hakime, Ernesto Pearson, Geoffroy Farouil, Christophe Teriitehau & Lambros Tselikas

Univeristy Paris-Sud, Le Kremlin Bicetre, F-94276, France

Frederic Deschamps, Thierry de Baere & Lambros Tselikas

AuthorsFrederic DeschampsView author publications