Percutaneous cement augmentations of malignant lesions of the sacrum and pelvis

Abstract

Background and purpose: Although cement augmentation has been described in the literature for the treatment of benign sacral insufficiency fractures, only a few case reports have described the procedure's usage in the treatment of malignant lesions. The purpose of this study was to evaluate the feasibility, effectiveness, safety, and clinical outcome for percutaneous cement augmentation of patients with malignant lesions in the sacrum and pelvis.

Materials and methods: A prospective study of 12 patients (7 men and 5 women) with a median age of 64.5 years was conducted under appropriate institutional review board protocol. Patients had different types of malignant metastatic lesions of the sacrum and pelvic bones. All but 1 patient underwent preprocedure CT and MR imaging. All patients had a postprocedure CT, and all but 1 had sacral lesions. Six patients had a second lesion in the iliac bones. Under CT guidance, percutaneous cement augmentation was performed in 8 cases and under fluoroscopy guidance in 2 cases. In 2 cases, needles were placed under CT guidance, and the injection was performed under fluoroscopy. In 5 patients, a single needle was used; in another 5 patients, 2 needles were used. One patient had 3 needles, and another patient required 4 needles.

Results: Adequate cement deposition was seen in all cases. Three patients had minimal clinically insignificant cement leakage. All treated patients (except 1 patient) reported decreased pain level with use of the visual analog scale (VAS) within 2 to 4 weeks of follow-up. No other subsequent surgical interventions were required.

Conclusions: Percutaneous cement augmentation of metastatic lesions of the sacrum and pelvic bones is a feasible and safe technique that can be performed under CT or fluoroscopic guidance. The technique results in decreased pain relief on short-term follow-up that can allow patients to tolerate future treatment.

Fig 1.

A 44-year-old woman with metastatic breast cancer to the sacrum and lumbar spine. A, Axial T1-weighted image showing the tumor extension with low signal intensity involving the right sacral ala and most of the body of S1 vertebra. B, Corresponding axial CT image showing the extent of the tumor. C, Axial CT image showing placement of 2 needles. D and E, Postprocedure CT images showing the final distribution of the cement. Patient VAS score went from 9/10 before the procedure to 2/10 at the follow-up visit.