Percutaneous Sacroplasty and Sacroiliac Joint Cementation under Fluoroscopic Guidance for Lower Back Pain Related to Sacral Metastatic Tumors with Sacroiliac Joint Invasion

Abstract

Cancer patients with bone metastases are at risk of a variety of skeletal events, including vertebral compression and pathologic fractures. Approximately 30% to 40% of patients with advanced lung cancer will develop bone metastases in the course of their disease, resulting in a significant negative impact on both morbidity and survival. Skeletal complications of bone metastases include pain, pathologic fractures, spinal cord compression, and hypercalcemia. The spine is the most frequent site of skeletal metastases. We present a 48-year-old female with intractable and incapacitating low back pain because of metastatic bone tumor in the left lateral side of S1 and S2 with left sacroiliac invasion. Imaging identified a metastatic invasion of the sacrum. Percutaneous sacroplasty, a safe and effective procedure for sacral-insufficient fractures, was performed under fluoroscopy guidance. However, the expected pain relief was not achieved. At 1 month, the patient remained invalided by severe back pain, which was localized to the left sacroiliac joint. In a second procedure, the sacroiliac joint was cemented. Pain relief was complete, immediate, and sustained until the patient's death related to the underlying oncologic disease. No complications were observed. Few reports exist about the treatment of sacral metastatic tumors with percutaneous sacroplasty. Further, no previous reports about sacroiliac joint cementation for joint stabilization have been found. In the present case, sacroiliac joint cementation successfully resolved residual pain that remained despite percutaneous sacroplasty treatment of the pathologic sacral fracture.

Management of metastatic sacral tumours

“…After screening, 16 studies were found to be eligible for inclusion (1 prospective cohort study on radiosurgery (level II) [32]; 2 case series (level III) [28,33]; 4 retrospective case series (level IV) [2,10,34,35] and 9 case reports (level IV) [36][37][38][39][40][41][42][43][44]; Table 1). …”

“…The available data on this are based primarily on level IV studies [36,38,39,41] and all cases treated with sacroplasty have shown immediate improvement in mobility and significant pain relief (Table 3).…”

Reconstruction With 3D-Printed Prostheses After Sacroiliac Joint Tumor Resection: A Retrospective Case-Control Study

“…When the stability of the sacroiliac complex is damaged, the sacroiliac joint is prone to rotation or vertical shear instability under pelvic load conditions, which is likely to lead to sacroiliac pain ( 17 ). Synovial metabolism is fast on the sacral surface of the sacroiliac joint, and the blood supply is rich; therefore tumors, tuberculosis, and other lesions are mostly located on the side of the sacrum ( 18 ). Whether reconstruction is beneficial after iliosacral tumor resection remains controversial ( 19 ).…”

Sacroplastia

“…Tras el procedimiento el paciente es trasladado a la unidad de recuperación postanestésica para su monitorización y cuidado postoperatorio (17,18). fig.…”