CT fluoroscopy-guided percutaneous osteoplasty with or without radiofrequency ablation in the treatment of painful extraspinal and spinal bone metastases: technical outcome and complications in 29 patients

Burgard, Caroline; Dinkel, Julien; Strobl, Frederik F.; Paprottka, Philipp; Schramm, Nicolai; Reiser, Maximilian; Trumm, C.

doi:10.5152/dir.2018.17265

Cited by 16 publications

(12 citation statements)

References 49 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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“…RFA can solidify the vascular tissue around the tumor and form microthrombosis in the tumor blood vessel, thus reducing the venous leakage of bone cement during PKP. RFA reduces the pathologic fractures induced by tumor progression and indirectly improves the role of PKP in preventing pathologic fractures [ 24 ]. PKP can strengthen the diseased vertebral body after PRF treatment and prevent the pathological fracture of vertebral body induced by RFA.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

Geng

et al. 2020

BMC Neurol

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Background To investigate the clinical efficacy and safety of bone cement combined with radiofrequency ablation (RFA) in the treatment of spinal metastases. Methods The medical records of patients with spinal metastatic tumor admitted to our hospital from January 2016 to December 2018 were retrospectively analyzed. Based on different surgical methods, the patients were divided into groups A (treated with RFA combined with bone cement) and B (treated with bone cement only). Group A included 35 patients with 47 segments of diseased vertebral bodies. Group B consisted of 52 patients with 78 vertebral segments. Pain, quality of life score, vertebra height, bone cement leakage, postoperative tumor recurrence, and complications were assessed 3 days and 1 and 6 months after surgery. Results All the patients had smooth operation without paraplegia, spinal cord injury, and perioperative death. Visual analogue scales (VAS) and Oswestry Disability Index (ODI) scores of the two groups significantly improved 3 days and 1 month after surgery compared with those before surgery (P < 0.05), but no significant difference was observed between the two groups (P > 0.05). Six months after surgery, the VAS and ODI scores of patients in group A were lower than those in group B, with statistically significant differences (P < 0.05). The postoperative vertebral body height of the two groups significantly increased compared with that before surgery, and the difference was statistically significant (P < 0.05). Meanwhile, no significant difference was observed between the two groups (P > 0.05). Postoperative bone cement permeability in group A was 6.4%, and postoperative tumor recurrence rate was 11.4%. The permeability of bone cement in group B was 20.5%, and the tumor recurrence rate was 30.8%. The bone cement permeability and tumor recurrence rate in group A were lower than those in group B, with statistically significant differences (P < 0.05). Conclusions Bone cement combined with RFA for the treatment of spinal metastases can achieve good efficacy, desirable analgesic effect, low incidence of complications, small surgical trauma, and high safety. The proposed method has the value of clinical popularization and application.

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“…CT‐guided procedures 34 are widely used as they enable accurate localization and are suitable for any site, including complex sites such as the pelvis and spine 28,29 . In the current study, CT guidance was used in 16 patients with lesions near the pelvis and ribs.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Controlling Metastatic Osseous Pain Using Three Kinds of Image‐Guided Procedures for Thermal Microwave Ablation: A Retrospective Study

Cheng

Yang

et al. 2020

Orthopaedic Surgery

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Objectives To evaluate the feasibility and safety of treating painful osseous metastases using image‐guided percutaneous thermal microwave ablation. Methods This is a retrospective study of patients treated from December 2016 to December 2019 in one institute. A total of 50 patients (35 men, 15 women; mean age 55.24 ± 11.03 years) with 56 osseous metastatic lesions underwent image‐guided percutaneous microwave ablation. There were 7 patients with multiple and 43 patients with single metastases. The numbers of patients with primary cancer were as follows: lung, 13; liver, 17; kidney, 10; prostate, 1; breast, 3; osteosarcoma, 1; and thyroid, 5. Seventeen patients had cancer combined with soft tissue masses. The radiological images for the ablative procedures were obtained by CT, fluoroscopy with ultrasound, and fluoroscopy alone in 16, 11, and 23 patients, respectively. Pain severity was estimated using the visual analogue scale before and after treatment (1 week, 1 month, and 3 months after treatment). Radiological evaluations were performed at baseline and 3 months after the procedure. Results In all patients, pain reduction occurred from the first day after treatment. Pain did not recur during the 3 months of follow up. The mean total ablation time per microwave electrode was 3.99 ± 2.48 min (range, 1–15 min). The mean power of the microwave electrode was 66.40 ± 12.08 W. The average volume of bone (load‐bearing bone, such as vertebra and acetabulum) cement after ablation was 2.82 ± 0.81 mL. There were no significant differences in visual analogue scale pain scores for different imaging techniques or ablation energies. No procedure‐related complications occurred. Conclusion Image‐guided percutaneous thermal microwave ablation of osseous metastases relieves pain and improves mobility. CT remains the first choice for percutaneous ablation. Fluoroscopy combined with ultrasound is effective for cases with soft tissue masses; fluoroscopy is also suitable for combination with vertebroplasty. However, further investigations are required.

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CT fluoroscopy-guided percutaneous osteoplasty with or without radiofrequency ablation in the treatment of painful extraspinal and spinal bone metastases: technical outcome and complications in 29 patients

Abstract: CT fluoroscopy-guided percutaneous osteoplasty with or without concomitant RFA for the treatment of painful extraspinal and spinal osteolyses can be performed with a low complication rate and high technical success.

Cited by 16 publications

References 49 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

Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

Feasibility of Controlling Metastatic Osseous Pain Using Three Kinds of Image‐Guided Procedures for Thermal Microwave Ablation: A Retrospective Study

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