Top

European Radiology

Published in:

01-09-2017 | Interventional

Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region

Authors: Kévin Premat, Frédéric Clarençon, Raphael Bonaccorsi, Vincent Degos, Évelyne Cormier, Jacques Chiras

Published in: European Radiology | Issue 9/2017

Abstract

Objectives

In long bones, cementoplasty alone does not provide sufficient stability, which may cause secondary fractures. This study reviewed the safety and efficacy of reinforced cementoplasty (RC) (percutaneous internal fixation using dedicated spindles combined with cementoplasty) for unstable malignant lesions of the cervicotrochanteric region (CTR) of the proximal femur.

Methods

Eighteen consecutive patients (nine women [50%] and nine men [50%]; mean age 55.1 ± 16.2 years; range 22–85) underwent RC for 19 unstable lesions of the CTR (16/19 [84.2%] bone metastases, 3/19 [15.8%] multiple myeloma lesions). All the patients were considered unsuitable for surgery. Clinical outcome was judged with a mean follow-up of 8.8 ± 7.2 months (range 1–27). The primary endpoints were occurrence of secondary fractures during the follow-up period and local pain relief measured by a visual analogue scale (VAS).

Results

No secondary fracture occurred. Mean VAS improved from 5.9 ± 3.1 (range 0–10) to 2.3 ± 2.4 (range 0–7) at 1 month (p = 0.001) to 1.6 ± 1.7 (range 0-5) at final follow-up (p = 0.0002). One symptomatic cement pulmonary embolism was recorded.

Conclusion

RC is an original minimally invasive technique providing pain relief and effective bone stability for unstable malignant lesions of the cervicotrochanteric region in patients unsuitable for open surgery.

Key Points

• Reinforced cementoplasty (RC) combines intralesional spindling with cementoplasty.

• RC provides effective bone stability and pain relief.

• RC is a suitable minimally invasive option for patients in poor general condition.

Harrington KD (1995) Orthopaedic management of extremity and pelvic lesions. Clin Orthop 136–147

Schneiderbauer MM, Sierra RJ, Schleck C et al (2005) Dislocation rate after hip hemiarthroplasty in patients with tumor-related conditions. J Bone Joint Surg Am 87:1810–1815PubMed

Nathan SS, Healey JH, Mellano D et al (2005) Survival in patients operated on for pathologic fracture: implications for end-of-life orthopedic care. J Clin Oncol Off J Am Soc Clin Oncol 23:6072–6082CrossRef

Popken F, Schmidt J, Oegur H et al (2002) Treatment outcome after surgical management of osseous breast carcinoma metastases. Preventive stabilization vs. management after pathological fracture. Unfallchirurg 105:338–343CrossRefPubMed

Mirels H (1989) Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 256–264

Swanson KC, Pritchard DJ, Sim FH (2000) Surgical treatment of metastatic disease of the femur. J Am Acad Orthop Surg 8:56–65CrossRefPubMed

Weill A, Chiras J, Simon JM et al (1996) Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology. doi:10.1148/radiology.199.1.8633152 PubMed

Anselmetti GC, Manca A, Ortega C et al (2008) Treatment of extraspinal painful bone metastases with percutaneous cementoplasty: a prospective study of 50 patients. Cardiovasc Intervent Radiol 31:1165–1173CrossRefPubMed

Tian Q-H, He C-J, Wu C-G et al (2015) Comparison of percutaneous cementoplasty with and without interventional internal fixation for impending malignant pathological fracture of the proximal femur. Cardiovasc Intervent Radiol 39:81–89CrossRefPubMed

10.

Liu X-W, Jin P, Liu K et al (2017) Comparison of percutaneous long bone cementoplasty with or without embedding a cement-filled catheter for painful long bone metastases with impending fracture. Eur Radiol 27:120–127CrossRefPubMed

11.

Deschamps F, Farouil G, Hakime A et al (2012) Cementoplasty of metastases of the proximal femur: is It a safe palliative option? J Vasc Interv Radiol 23:1311–1316CrossRefPubMed

12.

Kim Y, Kang HG, Kim TS et al (2014) Palliative percutaneous stabilization of lower extremity for bone metastasis using flexible nails and bone cement. Surg Oncol 23:192–198CrossRefPubMed

13.

Deschamps F, Farouil G, Hakime A et al (2011) Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol 35:1428–1432CrossRefPubMed

14.

Young J, Badgery-Parker T, Dobbins T et al (2015) Comparison of ECOG/WHO performance status and ASA score as a measure of functional status. J Pain Symptom Manag 49:258–264CrossRef

15.

Singh RK, Chaturvedi JP, Agrawal HS, Agrawal N (2016) Lower limb orthopedic surgery in geriatric patients under paravertebral blocks: a prospective feasibility study. Med J Armed Forces India 72:215–219CrossRefPubMedPubMedCentral

16.

Lin PP, Kang HG, Kim Y et al (2015) Minimally invasive surgery for femoral neck fractures using bone cement infusible hollow-perforated screw in high-risk patients with advanced cancer. Surg Oncol 24:226–231CrossRefPubMed

17.

Kang HG, Roh YW, Kim HS (2009) The treatment of metastasis to the femoral neck using percutaneous hollow perforated screws with cement augmentation. J Bone Joint Surg (Br) 91:1078–1082CrossRef

18.

Ristevski B, Jenkinson RJ, Stephen DJG et al (2009) Mortality and complications following stabilization of femoral metastatic lesions: a population-based study of regional variation and outcome. Can J Surg J Can Chir 52:302–308

19.

Thien TM, Chatziagorou G, Garellick G et al (2014) Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the nordic arthroplasty register association database. J Bone Joint Surg Am 96:e167CrossRefPubMed

20.

Kim Y, Kang HG, Kim S et al (2013) Clinical outcome prediction of percutaneous cementoplasty for metastatic bone tumor using (18)F-FDG PET-CT. Ann Nucl Med 27:916–923CrossRefPubMed

21.

Galibert P, Deramond H, Rosat P, Le Gars D (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33:166–168PubMed

22.

Clarençon F, Jean B, Pham H-P et al (2011) Value of percutaneous radiofrequency ablation with or without percutaneous vertebroplasty for pain relief and functional recovery in painful bone metastases. Skelet Radiol 42:25–36CrossRef

23.

Cazzato RL, Buy X, Eker O et al (2014) Percutaneous long bone cementoplasty of the limbs: experience with fifty-one non-surgical patients. Eur Radiol 24:3059–3068CrossRefPubMed

24.

Deschamps F, de Baere T, Hakime A et al (2016) Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol 26:1631–1639CrossRefPubMed

25.

Gao H, Liu Z, Wang B, Guo A (2016) Clinical and functional comparison of endoprosthetic replacement with intramedullary nailing for treating proximal femur metastasis. Chin J Cancer Res Chung-Kuo Yen Cheng Yen Chiu 28:209–214CrossRefPubMed

26.

Venmans A, Lohle PNM, van Rooij WJ et al (2008) Frequency and outcome of pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty. AJNR Am J Neuroradiol 29:1983–1985CrossRefPubMed

27.

Baroud G, Crookshank M, Bohner M (2006) High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine 31:2562–2568CrossRefPubMed

28.

Tins BJ, Cassar-Pullicino VN, Lalam R, Haddaway M (2012) Venous air embolism in consecutive balloon kyphoplasties visualised on CT imaging. Skelet Radiol 41:1093–1098CrossRef

29.

Andersen KH, Nielsen JM (1998) Heat of polymerization of bone cement can induce cardiac arrest. Ugeskr Laeger 160:4905–4906PubMed

Title: Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region
Authors: Kévin Premat
Frédéric Clarençon
Raphael Bonaccorsi
Vincent Degos
Évelyne Cormier
Jacques Chiras
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 9/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4774-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 9/2017

The prognostic value of right ventricular long axis strain in non-ischaemic dilated cardiomyopathies using standard cardiac magnetic resonance imaging

High b-value diffusion-weighted imaging in progressive multifocal leukoencephalopathy in HIV patients

Digital subtraction CT angiography for the detection of posterior inferior cerebellar artery aneurysms: comparison with digital subtraction angiography

Non-specific benign pathological results on transthoracic core-needle biopsy: how to differentiate false-negatives?

Diagnosis of small posterior fossa stroke on brain CT: effect of iterative reconstruction designed for brain CT on detection performance

Efficacy of a dynamic collimator for overranging dose reduction in a second- and third-generation dual source CT scanner