Prophylactic Percutaneous Consolidation of Large Osteolytic Tumors of the Pelvic Ring Using Fixation by Internal Cemented Screws

Abstract

Purpose To evaluate the efficacy, durability, and safety of percutaneous fixation by internal cemented screw (FICS) for prophylactic consolidation of impending pathologic fractures of the pelvic ring. Materials and Methods In this single-institute retrospective study, patients with large, minimally symptomatic to asymptomatic osteolytic tumors of the pelvic ring that were treated with percutaneous cone-beam CT-guided FICS procedures were included (January 2014 to May 2019). Follow-up cross-section imaging and clinical reports were reviewed for procedural complications and assessment of the long-term consolidation efficacy on the basis of the development of pathologic fracture or need for additional surgical intervention. All continuous variables were expressed as a mean with standard deviation, and dichotomous variables were expressed as frequencies and percentages. Results Fifty consecutive patients (mean age, 60 years ± 12; 27 men) underwent prophylactic FICS for consolidation of 54 osteolytic tumors (mean size, 51 mm ± 21.5; range, 30-114 mm). Local tumor destruction was performed in association with FICS in 38 patients (76%) using percutaneous thermal and/or radiation therapy. Follow-up exceeded a year in 35 patients (70%), with mean follow-up of 22 months ± 18 (range, 1-67 months). Long-term consolidation efficacy was 98% (49 of 50), with the development of a pathologic fracture in only one patient 20 months after FICS. Procedural complications were limited to two patients with self-resolving hematoma, one patient with inflammatory sciatic pain, and one patient with focal pain at the ischial tuberosity. Conclusion Percutaneous FICS provides a safe and durable minimally invasive treatment for the prevention of pathologic fractures of the pelvic ring. Keywords: Interventional-MSK, Percutaneous, Skeletal-Axial, Metastases, Oncology Supplemental material is available for this article. © RSNA, 2020.

Keywords: Interventional-MSK; Metastases; Oncology; Percutaneous; Skeletal-Axial.

Figure 1:

Flow diagram of inclusion and exclusion of patients within the study. FICS = fixation by internal cemented screw.

Figure 2:

Example of prophylactic fixation by internal cemented screw (FICS) by using the anchorage technique. Images in a 51-year-old woman with metastatic renal cancer who underwent radiation therapy 9 days prior to fixation by FICS. A, Preprocedural axial noncontrast CT image shows a 51-mm–wide osteolytic sacral metastasis with extensive cortical disruption. B, Postprocedural axial noncontrast CT image shows one of the transsacroiliac screws with anchorage cement at the tip. FICS steps: C, Insertion of two 8-gauge needles by the right transsacroiliac track; D, injection of polymethyl methacrylate cement through the needles; E, exchange of the needles over Kirschner wires and insertion of two 8-mm and 10-cm screws; and, F, withdrawal of the wires and final result.

Figure 3:

Example of prophylactic fixation by internal cemented screw (FICS) by using both anchorage and consolidation techniques. Images in a 63-year-old woman with multiple myeloma who underwent radiation therapy 2 months prior to FICS. A, Preprocedural sagittal noncontrast CT image shows a 63-mm–wide osteolytic tumor of the acetabulum involving the superior acetabular wall. B, Postprocedural sagittal noncontrast CT image shows the anterior transiliac screw and additional cement for consolidation FICS steps: C, insertion of two 8-gauge needles by the ascending and descending anterior transiliac tracks; D, injection of polymethyl methacrylate cement through the needles; E, insertion of one 8-mm and 11.5-cm screw through the ascending transiliac track; and, F, final result from a straight frontal view.