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Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

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Abstract

Aim

To review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres.

Materials and methods

Thirty-two consecutive patients (mean age 67.5 years; range 33–86 years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1 = worse; 2 = stable; 3 = improved; 4 = significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated.

Results

Thirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2 %); including 47.2 % PF, 13.9 % InF, and 38.9 % ImF. Cementoplasty was performed in 63.9 % of the cases. Technical success was 91.6 %. Hospital stay was ≤3 days; 87.1 % of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5 %) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures.

Conclusions

PIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.

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References

  1. Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fossa SD, Chodacki A, Wiechno P, Logue J, Seke M, Widmark A, Johannessen DC, Hoskin P, Bottomley D, James ND, Solberg A, Syndikus I, Kliment J, Wedel S, Boehmer S, Dall’Oglio M, Franzen L, Coleman R, Vogel-zang NJ, O’Bryan-Tear CG, Staudacher K, Garcia-Vargas J, Shan M, Bruland OS, Sartor O, Investigators A. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 2013;369(3):213–23.

    Article  CAS  PubMed  Google Scholar 

  2. Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12:6243s–9s.

    Article  PubMed  Google Scholar 

  3. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2007. Cancer CA Cancer J Clin. 2007;57:43–66.

    Article  PubMed  Google Scholar 

  4. Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am. 2004;15:365–73.

    Article  PubMed  Google Scholar 

  5. Deschamps F, Farouil G, Hakime A, Barah A, Guiu B, Teriitehau C, Auperin A, deBaere T. Cementoplasty of metastases of the proximal femur: is it a safe palliative option? J Vasc Interv Radiol. 2012;23(10):1311–6. doi:10.1016/j.jvir.2012.06.027.

    Article  PubMed  Google Scholar 

  6. Piccioli A, Spinelli MS, Maccauro G. Impending fracture: a difficult diagnosis. Injury. 2014;45(Suppl 6):S138–41.

    Article  PubMed  Google Scholar 

  7. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–64.

    PubMed  Google Scholar 

  8. Manglani HH, Marco RA, Picciolo A, Healey JH. Orthopedic emergencies in cancer patients. Semin Oncol. 2000;27:299–310.

    CAS  PubMed  Google Scholar 

  9. Body JJ, Pereira J, Sleeboom H, Maniadakis N, Terpos E, Acklin YP, Finek J, Gunther O, Hechmati G, Mossman T, Costa L, Rogowski W, Nahi H, von Moos R. Health resource utilization associated with skeletal-related events: results from a retrospective European study. Eur J Health Econ. 2015.

  10. Müller DA, Capanna R. The surgical treatment of pelvic bone metastases. Adv Orthop. 2015;2015:525363. doi:10.1155/2015/525363.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Choy WS, Kim KJ, Lee SK, Yang DS, Jeung SW, Choi HG, Park HJ. Surgical treatment of pathological fractures occurring at the proximal femur. Yonsei Med J. 2015;56(2):460–5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Arvinius C, Parra JL, Mateo LS, Maroto RG, Borrego AF, Stern LL. Benefits of early intramedullary nailing in femoral metastases. Int Orthop. 2014;38(1):129–32.

    Article  PubMed  Google Scholar 

  13. Talbot M, Turcotte RE, Isler M, Normandin D, Iannuzzi D, Downer P. Function and health status in surgically treated bone metastases. Clin Orthop Relat Res. 2005;438:215–20.

    Article  PubMed  Google Scholar 

  14. Liu G, Hasan MY, Wong HK. Minimally invasive iliac screw fixation in treating painful metastatic lumbosacral deformity: a technique description and clinical results. Eur Spine J. 2016.

  15. Wedin R. Surgical treatment for pathologic fracture. Acta Orthop Scand Suppl. 2001;72(302):1–29.

    Google Scholar 

  16. Deschamps F, Farouil G, Hakime A, Teriitehau C, Barah A, de Baere T. Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol. 2012;35(6):1428–32.

    Article  PubMed  Google Scholar 

  17. Deschamps F, de Baere T, Hakime A, Pearson E, Farouil G, Teriitehau C, Tselikas L. Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol. 2015.

  18. Garnon J, Koch G, Ramamurthy N, Caudrelier J, Rao P, Tsoumakidou G, Cazzato RL, Gangi A. Percutaneous CT and fluoroscopy-guided screw fixation of pathological fractures in the shoulder girdle: technical report of 3 cases. Cardiovasc Intervent Radiol. 2016.

  19. Hartung MP, Tutton SM, Hohenwalter EJ, King DM, Neilson JC. Safety and efficacy of minimally invasive acetabular stabilization for periacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol. 2016.

  20. Trumm CG, Rubenbauer B, Piltz S, Reiser MF, Hoffmann RT. Screw placement and osteoplasty under computed tomographic-fluoroscopic guidance in a case of advanced metastatic destruction of the iliosacral joint. Cardiovasc Intervent Radiol. 2011;34(Suppl 2):S288–93.

    Article  PubMed  Google Scholar 

  21. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–202.

    Article  PubMed  Google Scholar 

  22. Selvan VT, Oakley MJ, Rangan A, Al-Lami MK. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury. 2004;35(2):136–41.

    Article  CAS  PubMed  Google Scholar 

  23. Ye Y, Hao J, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ. Optimizing stability in femoral neck fracture fixation. Orthopedics. 2015;38(10):625–30.

    Article  PubMed  Google Scholar 

  24. Cazzato RL, Palussière J, Buy X, Denaro V, Santini D, Tonini G, Grasso RF, Zobel BB, Poretti D, Pedicini V, Balzarini L, Lanza E. Percutaneous long bone cementoplasty for palliation of malignant lesions of the limbs: a systematic review. Cardiovasc Intervent Radiol. 2015;38(6):1563–72. doi:10.1007/s00270-015-1082-7 Epub 2015 Mar 24.

    Article  PubMed  Google Scholar 

  25. Palumbo BT, Nalley C, Gaskins RB 3rd, Gutierrez S, Alexander GE III, Anijar L, Nayak A, Cheong D, Santoni BG. Biomechanical analysis of impending femoral neck fractures: the role of percutaneous cement augmentation for osteolytic lesions. Clin Biomech (Bristol, Avon). 2014;29(3):289–95.

    Article  Google Scholar 

  26. Rüger M, Sellei RM, Stoffel M, von Rüden C. The effect of polymethyl methacrylate augmentation on the primary stability of cannulated bone screws in an anterolateral plate in osteoporotic vertebrae: a human cadaver study. Glob Spine J. 2016;6(1):46–52.

    Google Scholar 

  27. He D, Wu L, Sheng X, Xiao Q, Zhu Y, Yu W, Liu F, Zhu K. Internal fixation with percutaneous kyphoplasty compared with simple percutaneous kyphoplasty for thoracolumbar burst fractures in elderly patients: a prospective randomized controlled trial. Eur Spine J. 2013;22(10):2256–63.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kim J-B, Park S-W, Lee Y-S, Nam T-K, Park Y-S, Kim Y-B. The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc. 2015;58(4):357–62.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tian QH, He CJ, Wu CG, Li YD, Gu YF, Wang T, Xiao QP, Li MH. Comparison of percutaneous cementoplasty with and without interventional internal fixation for impending malignant pathological fracture of the proximal femur. Cardiovasc Intervent Radiol. 2016;39(1):81–9.

    Article  PubMed  Google Scholar 

  30. Cazzato RL, Buy X, Eker O, Fabre T, Palussiere J. Percutaneous long bone cementoplasty of the limbs: experience with fifty-one non-surgical patients. Eur Radiol. 2014;24(12):3059–68. doi:10.1007/s00330-014-3357-9.

    Article  PubMed  Google Scholar 

  31. Lin PP, Kang HG, Kim YI, Kim JH, Kim HS. Minimally invasive surgery for femoral neck fractures using bone cement infusible hollow-perforated screw in high-risk patients with advanced cancer. Surg Oncol. 2015;24(3):226–31.

    Article  PubMed  Google Scholar 

  32. Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ. Pedicle screw loosening: a clinically relevant complication? Eur Spine J. 2015;24(5):1005–16.

    Article  PubMed  Google Scholar 

  33. Muller ME, Allgöwer M, Schneider R, et al. Manual of internal fixation: techniques recommended by the AO/ASIF group. New York: Springer; 1995.

    Google Scholar 

  34. Cazzato RL, Bonichon F, Buy X, Godbert Y, de Figuereido BH, Pointillart V, Palussière J. Over ten years of single-institution experience in percutaneous image-guided treatment of bone metastases from differentiated thyroid cancer. Eur J Surg Oncol. 2015;41(9):1247–55.

    Article  CAS  PubMed  Google Scholar 

  35. Cazzato RL, Buy X, Grasso RF, Luppi G, Faiella E, Quattrocchi CC, Pantano F, BeomonteZobel B, Tonini G, Santini D, Palussiere J. Interventional Radiologist’s perspective on the management of bone metastatic disease. Eur J Surg Oncol. 2015;41(8):967–74.

    Article  CAS  PubMed  Google Scholar 

  36. He C, Tian Q, Wu CG, Gu Y, Wang T, Li M. Feasibility of percutaneous cementoplasty combined with interventional internal fixation for impending pathologic fracture of the proximal femur. J Vasc Interv Radiol. 2014;25(7):1112–7.

    Article  PubMed  Google Scholar 

  37. Abdel-Aal AK, Underwood ES, Saddekni S. Use of cryoablation and osteoplasty reinforced with Kirschner wires in the treatment of femoral metastasis. Cardiovasc Intervent Radiol. 2012;35(5):1211–5.

    Article  PubMed  Google Scholar 

  38. Anselmetti GC, Manca A, Chiara G, Tutton S, Iussich G, Gino G, Grignani G, Ortega C, Moselli N, Regge D. Painful pathologic fracture of the humerus: percutaneous osteoplasty with bone marrow nails under hybrid computed tomography and fluoroscopic guidance. J Vasc Interv Radiol. 2011;22(7):1031–4.

    Article  PubMed  Google Scholar 

  39. Kawai N, Sato M, Iwamoto T, Tanihata H, Minamiguti H, Nakata K. Percutaneous osteoplasty with use of a cement-filled catheter for a pathologic fracture of the humerus. J Vasc Interv Radiol. 2007;18(6):805–9.

    Article  PubMed  Google Scholar 

  40. Kelekis A, Filippiadis D, Anselmetti G, Brountzos E, Mavrogenis A, Papagelopoulos P, Kelekis N, Martin JB. Percutaneous augmented peripheral osteoplasty in long bones of oncologic patients for pain reduction and prevention of impeding pathologic fracture: the rebar concept. Cardiovasc Intervent Radiol. 2016;39(1):90–6.

    Article  CAS  PubMed  Google Scholar 

  41. Kelekis A, Martin JB, Anselmetti G, Filipiadis D. Regarding, “Percutaneous augmented peripheral osteoplasty in long bones of oncologic patients for pain reduction and prevention of impeding pathologic fracture: the rebar concept”: reply. Cardiovasc Intervent Radiol. 2016;39(3):479–80.

    Article  CAS  PubMed  Google Scholar 

  42. Steensma M, Healey JH. Trends in the surgical treatment of pathologic proximal femur fractures among Musculoskeletal Tumor Society members. Clin Orthop Relat Res. 2013;471(6):2000–6.

    Article  PubMed  Google Scholar 

  43. Nawathe S, Nguyen BP, Barzanian N, Akhlaghpour H, Bouxsein ML, Keaveny TM. Cortical and trabecular load sharing in the human femoral neck. J Biomech. 2015;48(5):816–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Interventional Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, HUS, 1, place de l’ Hôpital, 67000, Strasbourg, France

    Roberto Luigi Cazzato, Guillaume Koch, Georgia Tsoumakidou, Jean Caudrelier, Julien Garnon & Afshin Gangi

  2. Department of Radiology, Institut Bergonié, 229, Cours de l’Argonne, 33000, Bordeaux, France

    Xavier Buy, Vittorio Catena & Jean Palussiere

  3. Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Nitin Ramamurthy

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  1. Roberto Luigi Cazzato
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Correspondence to Roberto Luigi Cazzato.

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Conflict of interest

Roberto Luigi Cazzato, Guillaume Koch, Xavier Buy, Nitin Ramamurthy, Georgia Tsoumakidou, Jean Caudrelier, Vittorio Catena, Julien Garnon, Jean Palussiere and Afshin Gangi have no conflict of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Cazzato, R.L., Koch, G., Buy, X. et al. Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus. Cardiovasc Intervent Radiol 39, 1455–1463 (2016). https://doi.org/10.1007/s00270-016-1389-z

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