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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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.
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.
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.
KeywordsBone Fractures Screw fixation
Compliance with Ethical Standards
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.
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.
Informed consent was obtained from all individual participants included in the study.
- 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.CrossRefPubMedGoogle 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.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.Google Scholar
- 15.Wedin R. Surgical treatment for pathologic fracture. Acta Orthop Scand Suppl. 2001;72(302):1–29.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.Google Scholar
- 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.Google Scholar
- 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.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.CrossRefPubMedGoogle 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.CrossRefGoogle 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.CrossRefPubMedPubMedCentralGoogle 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
- 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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle Scholar