Fluoroscopy and Cone-Beam CT–guided Fixation by Internal Cemented Screw for Pathologic Pelvic Fractures

Abstract

To evaluate the safety and efficacy of palliative treatment of patients with pathologic pelvic by using fluoroscopy and cone-beam CT needle guidance software to perform percutaneous fixation by internal cemented screw (FICS). Materials and Methods: This single-center study involved retrospective analysis of 100 consecutive patients with cancer with pathologic pelvic fractures managed with percutaneous FICS. Image guidance was performed with fluoroscopy and cone-beam CT needle guidance software. Pain palliative outcomes and opioid use after FICS were compared by means of paired-sample t test. Results: A total of 107 percutaneous FICS procedures were performed from 2010 to 2017 to palliate 141 pathologic fractures in 100 patients (mean age, 65.0 years 6 17.6 [standard deviation; female age, 66.3 years 6 18.0; mean, 63.7 years 6 17.2]). Of 107 procedures, 104 (97.2%) were technically successful, with mean postprocedure hospitalization of 2 days 6 3. Complications occurred in 14 patients: focal pain at procedure site for longer than 48 hours (n = 5), hematoma (n = 3), progressive fracture despite fixation (n = 2), infection (n = 1), tumor track seeding (n = 1), and screw displacement (n = 2). In the 88 patients who completed early follow-up, mean numeric rating scale pain score was significantly improved at 6 weeks from 6.1 6 2.5 to 2.1 6 3.0 (P , .001). Opioid use was reduced at 6 weeks (preprocedure vs postprocedure, 91.3 g 6 121 vs 64.6 g 6 124, respectively; P = .04). Conclusion: Fluoroscopy and cone-beam CT-guided percutaneous fixation of pathologic pelvis fractures by internal cemented screw is a safe and effective approach that can reduce pain and opioid use.

Percutaneous Osteoplasty under Fluoroscopy and Cone-Beam CT guidance for Painful Sternal Metastases

“…Percutaneous insertion of a needle into the sternal lesion can be a challenge because of the contour deformity and the bony landmarks sabotage by lytic tumor. To meet this challenge, some imaging guidance technology has been applied to accurately and precisely perform insertion of a needle through minimally invasive means with use of both CT and uoroscopic guidance with sonography or CBCT (7,(12)(13)(14)(15). We perfer to use the uoroscopy and CBCT guidance to improve preprocedural trajectory planning, needle advancement tracking of and cement distribution through the sternum, to reduce the complexity of multiple device applications.…”

Emerging Concepts in the Surgical Management of Peri-Acetabular Metastatic Bone Disease

“…The addition of screws allows offers a more stable construct, particularly with sheer, rotational or distracting forces. Roux et al reported a single center case series of 100 patients with peri-acetabular metastases with percutaneous image-guided cementoplasty with acetabular column screw augmentation ( Figure 3 ) [ 24 ]. Patients experienced significant pain relief and reduction in opioid consumption postoperatively.…”

Interventional oncology at the time of COVID-19 pandemic: Problems and solutions

“…IO has now an increasing role in pain palliation. Percutaneous osteosynthesis and cementoplasty can be proposed to patient with bone metastases [49,50] [51][52][53]. Even if according to NHS guide, "Palliative radiotherapy where alleviation of symptoms would reduce the burden on other healthcare services, such as hemoptysis" is classified as a level 4 radiotherapy of priority on a scale from 1 to 5, and classified as a level 5 priority on the 1 to 6 scale level for of categorization of cancer patients inside of "curative therapy with a high (>50%) chance of palliation/temporary tumor control but < 1 year life extension" there is no mention of pain in this guide [38].…”

“…Once again pain treatment is beneficial to oncologic patients due to the possibility to treat patient in a single day hospital with very minor risks of prolonged hospitalization or need for intensive post-treatment care. The shortage in anesthetic resources including drugs such as curare and hypnotics lowers our access to general anesthesia and rachi-anesthesia is a very efficient surrogate to general anesthesia in the population of patients with painful pelvic bone metastases who can benefit from percutaneous osteosynthesis [50]. Short acting drug allows for treating a patient in the morning and discharge him on his feet in the late afternoon.…”