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European Radiology
Published in: European Radiology 6/2016

01-06-2016 | Interventional

Percutaneous osteosynthesis in the pelvis in cancer patients

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

Published in: European Radiology | Issue 6/2016

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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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Metadata
Title
Percutaneous osteosynthesis in the pelvis in cancer patients
Authors
Frederic Deschamps
Thierry de Baere
Antoine Hakime
Ernesto Pearson
Geoffroy Farouil
Christophe Teriitehau
Lambros Tselikas
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3971-1

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