In the advanced stages of malignant diseases such as breast cancer, prostate, bronchial, renal cell or thyroid carcinoma, multiple myeloma and lymphoma, metastases in the axial skeleton are common. They have a negative impact on the quality of life and worsen the respective prognosis of the patient. If the sacrum is affected, with destruction and consecutive pathological fracture, the cardinal symptom is disabling pain in the region of the lower lumbar spine and pelvis. Based on experiences with cement augmentation in patients with osteoporosis-induced insufficiency fractures, the aim of this research was to investigate the feasibility, safety and course of pain in patients with metastasis-induced bone destruction and pathological fractures.Materials and Methods
CT-guided balloon sacroplasty was carried out in 10 patients with metastasis-induced bone destruction of the os sacrum (5 multiple myelomas, 1 bronchial carcinoma, 1 rectum carcinoma, 1 hepatocellular carcinoma, 1 renal cell carcinoma, 1 urothelial cell carcinoma). The indication for cement augmentation was established in an interdisciplinary case conference with oncologists/specialists in internal medicine, orthopaedic/trauma surgeons, neurosurgeons and interventional radiologists. The procedure was performed under intubation anaesthesia and anaesthetic monitoring. Patients were placed prone in the CT scanner. Single-shot antibiotic prophylaxis was routinely given (cefazoline 2g i.v.). After establishment of the entry point and usual preparation, a K-wire was first introduced as far as the central tumour lesion via the short, or transiliacal axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times, partly overlapping in a central to peripheral direction. The PMMA cement was then injected into the preformed cavity using the low-pressure technique under CT single slice guidance. The procedure was completed by a spiral CT control in the thin-section technique with coronal and sagittal reformation. Pain intensity was determined using a visual analogue scale (VAS) before the procedure and on the 2nd postoperative day.Results
The balloon sacroplasty was technically feasible in all patients. The control CT scan showed a central distribution of the cement in the tumour lesion. No leakage of cement in the direction of the neuroforamina, iliosacral joints or visceral surface with venous and nerve plexus or into the intervertebral disk space L5/S1 occurred. On average, 6 (4–8) ml of PMMA cement were introduced per side treated. A significant reduction in pain according to the VAS occurred in all patients from 9.3 pre-operatively to 2.1 on the 2nd postoperative day. All patients could be re-mobilised after the procedure and could receive the further therapeutic measures as planned.Discussion
Balloon sacroplasty is a helpful therapeutic option in the overall palliative concept for patients with tumour-induced sacral destruction. It is a safe and practicable procedure that markedly reduces the disabling pain, increases the patient’s quality of life and greatly facilitates the feasibility of further necessary measures such as radiotherapy and chemotherapy.Disclosures
R. Andresen: None. S. Radmer: None. C. Luedtke: None. P. Kamusella: None. C. Wissgott: None. H. Schober: None.