Minimally invasive management of pathologic fractures of the pelvis and sacrum: Tumor ablation and fracture stabilization

Abstract

Background Pathologic fractures of the pelvis/sacrum due to metastatic bone disease (MBD) cause pain and dysfunction due to mechanical instability of the pelvic ring. This study presents our multi‐institutional experience with percutaneous stabilization of pathologic fractures and osteolytic lesions from MBD throughout the pelvic ring. Methods The records of patients undergoing this procedure from 2018 to 2022 were reviewed retrospectively from two institutions. Surgical data and functional outcomes were recorded. Results Fifty‐six patients underwent percutaneous stabilization, with a median operative duration of 119 min (interquartile range [IQR]: 92.8, 167) and median estimated blood loss of 50 mL (IQR: 20, 100). The median length of stay was 3 days (IQR: 1, 6), and 69.6% (n = 39) of patients were discharged home. Early complications included one partial lumbosacral plexus injury, three acute kidney injuries, and one case of intra‐articular cement extravasation. Late complications included two infections and one revision stabilization procedure for hardware failure. Mean Eastern Cooperative Oncology Group (ECOG) scores improved from 3.02 (SD 0.8) preoperatively to 1.86 (SD 1.1) postoperatively (p < 0.001). Ambulatory status also improved (p < 0.001). Conclusions Percutaneous stabilization of pathologic fractures and osteolytic defects of the pelvis and sacrum is a procedure that improves patient function, ambulatory status and is associated with a limited complication profile.

Minimally invasive stabilization of pelvic metastatic bone disease: A review of an emerging technique

“…Functional improvement has also been universally demonstrated across studies using multiple validated scoring systems including the Musculoskeletal Tumor Society (MSTS) score and the Eastern Cooperative Oncology Group (ECOG) score. 13,15,16,22 In our series of 56 patients, the percentage of patients who were bed-or wheelchair-bound improved from nearly 40% to 14% following percutaneous pelvic stabilization with screws and cement. 16…”

“…Cement extravasation into the hip joint has been reported in two series-one was asymptomatic and managed non-operatively and the other was augmented to a THA with good functional status in follow-up. 15,16 Nerve injury has also been reported-attributable to either external compression from positioning or from tumor ablation. 13,16 In our own series, there were three instances of acute kidney injury, which resolved with supportive treatment; however, these are likely not a unique consequence to the described procedure.…”

“…15,16 Nerve injury has also been reported-attributable to either external compression from positioning or from tumor ablation. 13,16 In our own series, there were three instances of acute kidney injury, which resolved with supportive treatment; however, these are likely not a unique consequence to the described procedure.…”

“…The available case series demonstrate a significant improvement in patients' pain and function as a result of percutaneous stabilization of pathologic fractures of pelvis. 12,13,15,16,22 Due to this success and the significant morbidity associated with pathologic pelvis fractures, there is interest in the role of prophylactic intervention. The consideration for prophylactic intervention of an impending pathologic pelvis fracture is similar to that for impending long bone pathologic fractures.…”

“…Within the past few years, a handful of institutions have published series on minimally invasive techniques for the surgical management of pelvic MBD. [11][12][13][14][15][16] Slight variations in techniques exist across institutional series. In general, the stabilization of pelvic MBD is achieved through the percutaneous implantation of (1) fully-threaded cannulated screws and cement (to act as cement and rebar in pathologic bone) or (2) photodynamic balloons (IlluminOss ® , IlluminOss Medical Inc.) that allow for filling and spanning of osteolytic defects.…”