Percutaneous Cementoplasty for the Pelvis in Bone Metastasis: 12-Year Experience

Abstract

Background. In advanced cancer patients, pelvic bone metastasis often causes pain and gait disturbance. The use of percutaneous bone cement [polymethylmethacrylate (PMMA)] injection for pain management and strengthening in pelvic bone metastasis has rarely been reported. To evaluate this method, we aimed to determine surgical outcomes and complications over a long-term follow-up period using a large patient group. Patients and Methods. We retrospectively collected data from 178 patients who underwent percutaneous cementoplasty for pelvic metastatic lesions, 201 in total. Surgical outcomes evaluated included pain reduction and improvement of ambulation. Mortality within 1 month after procedure and pulmonary embolism caused by thrombus, fat, tumor emboli, or bone cement were investigated as surgical complications. For long-term survivors, pain relapse and mechanical failure were analyzed. The mean follow-up period was 12.6 months, and there were 159 fatalities at last follow-up. Results. The mean regional pain numerical rating scale scores decreased from 6.1 preoperatively to 2.4 1 month after procedure (p \ 0.01). Gait function was maintained, worsened, and uncheckable in 68%, 24%, and 8% of patients, respectively, 1 month after procedure. Of long-term survivors followed up for [ 12 months (n = 53), there were no significant changes in serial plain radiographs, and regional pain aggravation was observed in 9%. Pulmonary cement embolism and bone cement implantation syndrome was observed in 11% and 10%, respectively. However, all patients with these complications were asymptomatic. Conclusions. Percutaneous cement injection into the pelvis is a feasible and safe palliative surgical option for patients with advanced malignancy in terms of pain reduction and maintenance of ambulatory function under regional anesthesia.

O-arm-guided percutaneous microwave ablation and cementoplasty for the treatment of pelvic acetabulum bone metastasis

“…Through preoperative and intraoperative imaging measurements, we can implement accurate microwave ablation and cementoplasty to achieve satisfactory bone reinforcement, pain alleviation, greatly improved safety, and postoperative functional efficacy with the O-arm system. Kim et al ( 8 ) found that local complications and extraosseous bone cement leakage were often observed (36%, 72/201 of pelvises). Among them, 21 showed intraarticular leakage into the hip joint, and 51 showed leakage into areas other than the hip joint.…”

“…In some cases, in which medium-sized pelvic metastases, poor control after radiotherapy, local pain, and pathological fracture occur, surgical intervention can yield new problems, such as excessive bleeding, poor physical tolerance, the interruption of systemic treatment and radiotherapy, and adverse effects that result in the poor control of systemic tumors. Therefore, less invasive procedures, including percutaneous microwave ablation, radiofrequency ablation, cryoablation, and high-energy ultrasound with or without bone cement injection, have become salient options ( 8 ). While microwave ablation technology has been used for the treatment of bone tumors for more than 30 years and could be employed as an independent percutaneous minimally invasive treatment for benign bone tumors like Osteoid osteoma ( 9 ) and bone metastases ( 10 ).…”

Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review

“…Percutaneous cementoplasty has also proved to be a safe and effective choice for patients with painful osteolytic pelvic bone metastases, reducing pain and disability and improving function [ 161 , 162 , 163 ]. A study by Park et al evaluated percutaneous cement injection in 178 patients with pelvic bone lesions achieving a pain reduction according to a numerical pain score from 6.1 to 2.4 ( p < 0.01) and the maintenance of gait function in 68% of the patients [ 163 ].…”

Functional and Survival Outcomes of Patients following the Harrington Procedure for Complex Acetabular Metastatic Lesions

“…The pelvis is the third most common site of skeletal metastases, and iliac lesions can lead to major functional deterioration, leading to complications of decubitus and a worse survival prognosis [ 9 ]. These lesions can be treated with cementoplasty [ 10 ] or total hip arthroplasty (THA) when the acetabulum is involved, but in a few cases, there is not enough bone support to position a conventional acetabular component. This situation cannot be treated with conventional techniques because of extensive bone loss, irradiated bone and soft tissues, and immunocompromised status [ 11 ].…”