Balloon Sacroplasty as a Palliative Pain Treatment in Patients with Metastasis-Induced Bone Destruction and Pathological Fractures

Andresen, Reimer; Radmer, Sebastian; Lüdtke, C. W.; Kamusella, P; Wissgott, Christian; Schober, Hans-Christof

doi:10.1055/s-0033-1356418

Cited by 17 publications

(6 citation statements)

References 12 publications

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“…In the present study, PSP was found to be feasible and highly efficacious, and pain relief and functional improvement were early and adequate. After PSP, 90% of the patients experienced immediate and significant improvement of pain and mobility, similar to other previously published literature (9111214). Therefore, PSP is a minimally invasive procedure that may be useful for patients with painful sacral metastases involving multiple sacral vertebral bodies–particularly for those in poor general condition–and offers several advantages over conventional treatments.…”

Section: Discussionsupporting

confidence: 89%

“…In recent years, image-guided PSP has emerged as a feasible and effective treatment for painful and disabling sacral metastases, and this technique aims to alleviate pain and regain mobility in a manner similar to PVP or percutaneous kyphoplasty (PKP) of the cervical and thoracolumbar spine. Several reports and small series have demonstrated this technique's efficacy in providing pain relief and bone stabilization, although the mechanism underlying its analgesic effect remains incompletely understood (9111214282930).…”

Section: Discussionmentioning

confidence: 99%

“…Although PSP was first utilized in a metastatic lesion of the sacrum for pain alleviation in the year 2000 (4), PSP for osteoporotic SIFs is well-described and widely reported (567). However, published literature describing the treatment of patients with painful sacral tumors is limited (891011121314), with even scarcer descriptions for sacral metastases (9111214).…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Sacroplasty for Painful Sacral Metastases Involving Multiple Sacral Vertebral Bodies: Initial Experience with an Interpedicular Approach

et al. 2019

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Objective To report our initial experience of percutaneous sacroplasty (PSP) with an interpedicular approach for treating painful sacral metastases involving multiple sacral vertebral bodies. Materials and Methods This study prospectively enrolled 10 consecutive patients (six men and four women; mean age, 56.3 ± 13.8 years) who underwent PSP for painful sacral metastases involving multiple sacral vertebral bodies from March 2017 to September 2018. Visual analogue scale (VAS) scores, Oswestry disability index (ODI) values, and the number of opioids prescribed to the patients were assessed before and after PSP. The procedure duration, length of hospitalization, and complications were also recorded. Results Mean VAS and ODI declined significantly from 6.90 ± 1.20 and 74.40 ± 5.48 before the procedure to 2.70 ± 1.34 and 29.60 ± 14.57 after the procedure, respectively ( p < 0.01). The median number of opioids prescribed per patient decreased from 2 (interquartile range [IQR] 1-3) pre-procedure to 1 (IQR 0–3) post-procedure ( p < 0.01). Nine of the 10 patients showed no or decreased opioid usage, and only 1 patient showed unchanged usage. The mean procedure duration was 48.5 ± 3.0 minutes. The average length of hospitalization was 4.7 ± 1.7 days. Extraosseous cement leakage occurred in three cases without causing any clinical complications. Conclusion PSP with an interpedicular approach is a safe and effective treatment in patients with painful sacral metastases involving multiple sacral vertebral bodies and can relieve pain and improve mobility.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous Sacroplasty for Painful Sacral Metastases Involving Multiple Sacral Vertebral Bodies: Initial Experience with an Interpedicular Approach

et al. 2019

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“…Mit der Dual-Energy-Computertomografie kann durch die hohe Ödemsensitivität und gleichzeitige Frakturvisualizierung im CT-Schnittbild eine weitere Verbesserung der Treffsicherheit erreicht werden, ohne dass die Strahlendosis im Vergleich zum Standard-CT weiter steigt [33,34]. Die CT kann auch hilfreich sein, wenn versucht wird, eine Fraktur von einer metastasierten Erkrankung zu unterscheiden, da sie bei einer Tumorbeteiligung eine kortikale Zerstörung und/oder eine Weichteilmasse zuverlässig darstellen kann [35,36].…”

Section: Bildgebungunclassified

Diagnostik und Behandlung von sacralen Insuffizienzfrakturen unter besonderer Berücksichtigung der Zementaugmentationsverfahren – eine Übersicht

et al. 2020

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ZusammenfassungInsuffizienzfrakturen des Os sacrum werden in letzter Zeit immer häufiger detektiert, wobei aufgrund der steigenden Lebenserwartung die Inzidenz weiter zunehmen wird. Ein Teil der Patienten ist, bedingt durch die starken Frakturschmerzen, invalidisiert und lässt sich durch eine konservative Behandlung nicht suffizient therapieren. Mittels Zementeinbringung in die entsprechende Frakturzone lässt sich eine deutliche Schmerzreduktion und klinische Verbesserung herbeiführen. Ziel dieser Übersichtsarbeit ist eine Darstellung der unterschiedlichen Zementaugmentationsverfahren Ballon-, Radiofrequenz-, Vertebro- und Zementsakroplastie hinsichtlich der richtigen Indikation, der technischen Durchführbarkeit, den möglichen Komplikationen und des klinischen Outcomes. Die Grenzen der Sakroplastie und die Indikation zur Durchführung unterschiedlicher Osteosyntheseverfahren werden aufgezeigt.Eine Literaturrecherche in PubMed und GoogleScholar wurde zu den Stichworten durchgeführt: Beckeninsuffizienzfraktur, Fragilitätsfrakturen des Beckenrings, sacrale Insuffizienzfraktur, Os sacrum, Osteoporose, interventionelle Schmerztherapie, Sakroplastie, Zementaugmentation und Beckenosteosynthesen. Erfahrungen aus der seit Jahren bestehenden eigenen interdisziplinären und multizentrischen Arbeitsgruppe wurden mitberücksichtigt.Neue Klassifikationen in der Einteilung von Beckeninsuffizienzfrakturen sind bei der Festlegung des therapeutischen Vorgehens unter Beachtung der individuellen Klinik zu berücksichtigen. Eine konservative Therapie steht zunächst im Vordergrund, jedoch werden hier nicht alle Patienten schmerzfrei und lassen sich nicht adäquat mobilisieren, konsekutiv folgen Komorbiditäten und eine erhöhte Mortalität. Bei nichtdislozierten Frakturen lässt sich mittels Sakroplastie eine schnelle und nachhaltige Schmerzreduktion herbeiführen. Hinsichtlich der Zementaugmentation lassen sich osteoplastische Verfahren wie die Ballon-, Radiofrequenz- und Zementsakroplastie von dem nichtosteoplastischen Verfahren der Vertebrosakroplastie unterscheiden. Bei der Vertebrosakroplastie muss man mit einer höheren Zementleckagerate rechnen. Die komplexe sacrale Anatomie, die osteopene Knochenstruktur, die Ausrichtung der Frakturzonen, das unterschiedlich technische Vorgehen, die Eigenschaften der Zemente und die Erfahrung des Operateurs haben einen Einfluss auf das Auftreten möglicher Komplikationen.Wenn konservative Maßnahmen zu keiner klinischen Verbesserung führen, profitieren Patienten mit schmerzhaften, nichtdislozierten sacralen Insuffizienzfrakturen von einer Zementaugmentation effektiv und nachhaltig. Durch den Einsatz von individuell anzupassenden Sakroplastieverfahren sind relevante Komplikationen insgesamt sehr selten. Patienten mit instabilen Frakturen profitieren von einer rechtzeitig durchgeführten Osteosynthese.

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“…[5][6][7][8] However, the few studies to date on the use of PSP for the treatment of painful sacral metastases have had small sample sizes and/or did not examine the use of PSP in combination with other therapies. [9][10][11][12] The aim of this retrospective study was to assess the safety and efficacy of PSP under fluoroscopy for the treatment of painful sacral metastases unresponsive to conservative treatments and to compare long-term outcomes after treatment with PSP alone versus PSP plus radiofrequency ablation (RFA).…”

mentioning

confidence: 99%

Percutaneous Sacroplasty with or without Radiofrequency Ablation for Treatment of Painful Sacral Metastases

Tian

Han

Wang

et al. 2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Percutaneous sacroplasty is a variation of percutaneous vertebroplasty that has gained attention as a therapeutic option for patients with painful sacral insufficiency fractures due to osteoporosis or metastases. Additionally, percutaneous sacroplasty can also be used to treat painful sacral metastases without a pathologic fracture. The purpose of this retrospective study was to compare the efficacy and safety of fluoroscopy-guided percutaneous sacroplasty alone versus percutaneous sacroplasty plus radiofrequency ablation for the treatment of painful sacral metastases. MATERIALS AND METHODS:For this retrospective study, 126 patients (with a total of 162 painful sacral metastases) were enrolled from October 2012 to February 2021 and assigned to receive either percutaneous sacroplasty plus radiofrequency ablation (n ¼ 51, group A) or percutaneous sacroplasty alone (n ¼ 75, group B). Four different approaches were used for percutaneous sacroplasty: transiliac, interpedicular, anterior-oblique, and posterior. The Visual Analog Scale, Oswestry Disability Index, and Karnofsky Performance Scale were used to evaluate outcomes. RESULTS:The Visual Analog Scale, Oswestry Disability Index, and Karnofsky Performance Scale scores showed significant improvement in both groups after treatment (P , .05). The overall pain relief rate was significantly better in group A than in group B (90% versus 76%, P ¼ .032). There were no significant differences in the incidence of polymethylmethacrylate leakage between the 2 groups or among the 4 different approaches (P . .05).CONCLUSIONS: Both percutaneous sacroplasty alone and the combination of percutaneous sacroplasty and radiofrequency ablation are safe and effective for treatment of painful sacral metastases. The combination of percutaneous sacroplasty and radiofrequency ablation appears to be more effective than percutaneous sacroplasty alone.

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Balloon Sacroplasty as a Palliative Pain Treatment in Patients with Metastasis-Induced Bone Destruction and Pathological Fractures

Cited by 17 publications

References 12 publications

Percutaneous Sacroplasty for Painful Sacral Metastases Involving Multiple Sacral Vertebral Bodies: Initial Experience with an Interpedicular Approach

Percutaneous Sacroplasty for Painful Sacral Metastases Involving Multiple Sacral Vertebral Bodies: Initial Experience with an Interpedicular Approach

Diagnostik und Behandlung von sacralen Insuffizienzfrakturen unter besonderer Berücksichtigung der Zementaugmentationsverfahren – eine Übersicht

Percutaneous Sacroplasty with or without Radiofrequency Ablation for Treatment of Painful Sacral Metastases

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