Percutaneous osteoplasty techniques for bone metastases in the peripheral skeleton and impeding fractures: a pictorial review
D. Filippiadis, C. Konstantos, L. Reppas, S. Spiliopoulos, K. Palialexis, E. Brountzos, A. Kelekis
2nd Department of Radiology, University General Hospital "ATTIKON", Athens, Greece.
Percutaneous osteoplasty can be indicated as a palliative technique for patients suffering from fractures (pathological and nonpathological) or can be applied to provide prophylactic consolidation for patients with osteolytic metastases and impending pathological fractures.
Cannulated screws and peek polymers implants are commercially available devices that have been approved in the indication of osteosynthesis. Clinical and laboratory studies adittionally report the use of screws, nails, peek polymer implants, of cement filled catheters, of kirschner wires, of photo-activated polymers or of metallic mesh of microneedles in combination with PMMA injection for structural support in the peripheral skeleton. Which combinations of factors such as technique, lesion and location will be ideal still needs to be evaluated both in vitro and in vivo.
Bone metastases of the peripheral skeleton represent a frequent and serious morbidity in patients with advanced cancer disease. The choice of appropriate treatment depends on life expectancy, fracture risk and pain control and includes medication, radiotherapy, osteoplasty/cementoplasty, or surgical techniques. There is no clear criteria to state if an osteolyitc metastasis must be prophylactically consolidated or not. For proximal femur, the Mirel’s score is currently used to predict the risk of fracture (in case of a lesion scoring ≥8, prophylactic fixation is indicated ) but this score has been challenged by several studies. In clinical practice, it is commonly believed that pain and rupture of a large cortical by the bone metastases are two simple criteria that must be considered as predictive factors of fracture.
Prior to consolidation of osteolytic metastases, percutaneous ablation can be performed applying any kind of available energy including radiofrequency, microwave or cryoablation .
Concerning osteoplasty in the peripheral skeleton, depending on the location and the forces applied cement can be either solely injected or in combination to implants (metallic or not). Percutaneous augmented peripheral osteoplasty combining cement to instrumentation for symptomatic malignant lesions and pathologic fracture prevention in long bones seems is a safe and efficient technique for bone stabilization.