Korean J Radiol.  2019 Jun;20(6):939-946. 10.3348/kjr.2018.0803.

Percutaneous Sacroplasty for Painful Sacral Metastases Involving Multiple Sacral Vertebral Bodies: Initial Experience with an Interpedicular Approach

• Tian QH
• Liu HF
• Wang T
• Cheng YS
• Wu CG

• KMID: 2447072
• DOI: http://doi.org/10.3348/kjr.2018.0803

Abstract

OBJECTIVE
To report our initial experience of percutaneous sacroplasty (PSP) with an interpedicular approach for treating painful sacral metastases involving multiple sacral vertebral bodies.
MATERIALS AND METHODS
This study prospectively enrolled 10 consecutive patients (six men and four women; mean age, 56.3 ± 13.8 years) who underwent PSP for painful sacral metastases involving multiple sacral vertebral bodies from March 2017 to September 2018. Visual analogue scale (VAS) scores, Oswestry disability index (ODI) values, and the number of opioids prescribed to the patients were assessed before and after PSP. The procedure duration, length of hospitalization, and complications were also recorded.
RESULTS
Mean VAS and ODI declined significantly from 6.90 ± 1.20 and 74.40 ± 5.48 before the procedure to 2.70 ± 1.34 and 29.60 ± 14.57 after the procedure, respectively (p < 0.01). The median number of opioids prescribed per patient decreased from 2 (interquartile range [IQR] 1-3) pre-procedure to 1 (IQR 0-3) post-procedure (p < 0.01). Nine of the 10 patients showed no or decreased opioid usage, and only 1 patient showed unchanged usage. The mean procedure duration was 48.5 ± 3.0 minutes. The average length of hospitalization was 4.7 ± 1.7 days. Extraosseous cement leakage occurred in three cases without causing any clinical complications.
CONCLUSION
PSP with an interpedicular approach is a safe and effective treatment in patients with painful sacral metastases involving multiple sacral vertebral bodies and can relieve pain and improve mobility.

Keyword

Percutaneous sacroplasty; Sacral metastases; Interpedicular approach

MeSH Terms

Analgesics, Opioid
Female
Hospitalization
Humans
Male
Neoplasm Metastasis*
Prospective Studies
Analgesics, Opioid

Figure

• 

  Fig. 1 Schematic illustrations demonstrate steps involved in PSP with interpedicular approach. A, D. Placement of 13 G bevel needle in midline over sacral hiatus at level of fourth sacral vertebral body. Note rotation of sharp tip of bevel needle to avoid penetration toward foramen and anterior border of sacrum. B, E. Successful placement of 13 G bevel needle with interpedicular approach. C, F. During cement injection, bone needle cannula was gradually withdrawn as needed to allow greater area of cement deposition in lesions. PSP = percutaneous sacroplasty

• 

  Fig. 2 Sacral metastases of first and second sacral bodies from hepatoma in 72-year-old patient pre- and post-PSP. A, B. Preoperative enhanced T1 weighted image-weighted sagittal MRI and reformatted CT images of patient demonstrating osteoblastic metastasis on first and second sacral bodies. C–F. Intraoperative images showing puncture and bone cement injection for metastases of S1–2 bodies. G, H. Postoperative anterior/lateral radiographs of patient showing homogeneous and sufficient distribution of bone cement in lesion.

• 

  Fig. 3 Sacral metastases of second and third sacral bodies from lung cancer in 69-year-old patient pre- and post-PSP. A, B. Preoperative T2 weighted image-weighted sagittal MRI and reformatted CT images of patient demonstrating osteoblastic metastasis on second and third sacral bodies, right ilium, and left femur. C–F. Intraoperative images showing placement of bevel needle and bone cement injection for metastases of S2–3 bodies and right ilium. G, H. PSP procedure through interpedicular approach was completed with polymethyl methacrylate left in metastatic lesions.

• 

  Fig. 4 Changes in VAS, ODI, and pain medication usage following PSP. Changes in (A) VAS scores, (B) ODI scores, and (C) opioid prescriptions are shown. ODI = Oswestry disability index, op = operation, VAS = visual analogue scale

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