Percutaneous Fixation by Internal Cemented Screw for the Treatment of Unstable Osseous Disease in Cancer Patients

Abstract

Interventional radiology expertise in image guidance has expanded the treatment options for cancer patients with unstable osseous disease. Percutaneous fixation by internal cemented screw (FICS) describes the technique by which the interventional radiologist stabilizes a fracture or impending fracture with the percutaneous placement of a cannulated screw that is locked in position by polymethyl methacrylate cement. The durable metallic screws provide added resistance to torque and tension stresses that complement the axial compression resistance of cement. Compared with cementoplasty alone, the procedure has been advanced as a more durable and precise technique for stabilization of osseous disease for certain disease presentations in cancer patients. The application of advanced image guidance techniques improves upon existing percutaneous surgical techniques to facilitate approaches that would otherwise prove quite challenging, particularly with stabilization of the pelvic flat bones. This article examines the applications of percutaneous FICS procedures for the treatment of unstable osseous disease in cancer patients. Indications, techniques, and follow-up care are reviewed. Case examples in which FICS can be performed in unstable pathology are detailed.

Keywords

bone fracture - pain palliation - cement consolidation - screw fixation - cementoplasty - interventional radiology

• References

• 1 Tsuzuki S, Park SH, Eber MR, Peters CM, Shiozawa Y. Skeletal complications in cancer patients with bone metastases. Int J Urol 2016; 23 (10) 825-832
• 2 Hill T, D'Alessandro P, Murray K, Yates P. Prognostic factors following pathological fractures. ANZ J Surg 2015; 85 (03) 159-163
• 3 Kaemmerlen P, Thiesse P, Bouvard H, Biron P, Mornex F, Jonas P. [Percutaneous vertebroplasty in the treatment of metastases. Technic and results]. J Radiol 1989; 70 (10) 557-562
• 4 Anselmetti GC, Marcia S, Saba L. , et al. Percutaneous vertebroplasty: multi-centric results from EVEREST experience in large cohort of patients. Eur J Radiol 2012; 81 (12) 4083-4086
• 5 Wang Z, Zhen Y, Wu C. , et al. CT fluoroscopy-guided percutaneous osteoplasty for the treatment of osteolytic lung cancer bone metastases to the spine and pelvis. J Vasc Interv Radiol 2012; 23 (09) 1135-1142
• 6 Deschamps F, Farouil G, Hakime A. , et al. Cementoplasty of metastases of the proximal femur: is it a safe palliative option?. J Vasc Interv Radiol 2012; 23 (10) 1311-1316
• 7 Corcos G, Dbjay J, Mastier C. , et al. Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors. Spine 2014; 39 (05) E332-E338
• 8 Wong JM-L, Bucknill A. Fractures of the pelvic ring. Injury 2017; 48 (04) 795-802
• 9 Iorio JA, Jakoi AM, Rehman S. Percutaneous sacroiliac screw fixation of the posterior pelvic ring. Orthop Clin North Am 2015; 46 (04) 511-521
• 10 Hopf JC, Krieglstein CF, Müller LP, Koslowsky TC. Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients. Injury 2015; 46 (08) 1631-1636
• 11 Khaled SA, Soliman O, Wahed MA. Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation: single versus two screw fixation. Eur J Trauma Emerg Surg 2015; 41 (04) 387-392
• 12 van den Bosch EW, van Zwienen CMA, van Vugt AB. Fluoroscopic positioning of sacroiliac screws in 88 patients. J Trauma 2002; 53 (01) 44-48
• 13 Pieske O, Landersdorfer C, Trumm C. , et al. CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: accuracy of screw position, injury reduction and complications in 71 patients with 136 screws. Injury 2015; 46 (02) 333-339
• 14 Pishnamaz M, Dienstknecht T, Hoppe B. , et al. Assessment of pelvic injuries treated with ilio-sacral screws: injury severity and accuracy of screw positioning. Int Orthop 2016; 40 (07) 1495-1501
• 15 Wong JM-L, Bewsher S, Yew J, Bucknill A, de Steiger R. Fluoroscopically assisted computer navigation enables accurate percutaneous screw placement for pelvic and acetabular fracture fixation. Injury 2015; 46 (06) 1064-1068
• 16 Coste C, Asloum Y, Marcheix PS, Dijoux P, Charissoux JL, Mabit C. Percutaneous iliosacral screw fixation in unstable pelvic ring lesions: the interest of O-ARM CT-guided navigation. Orthop Traumatol Surg Res 2013; 99 (4, Suppl): S273-S278
• 17 Deschamps F, de Baere T, Hakime A. , et al. Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol 2016; 26 (06) 1631-1639
• 18 Strobl FF, Haeussler SM, Paprottka PM. , et al. Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring. Skeletal Radiol 2014; 43 (08) 1093-1100
• 19 Amoretti N, Huwart L, Hauger O. , et al. Percutaneous screw fixation of acetabular roof fractures by radiologists under CT and fluoroscopy guidance. AJR Am J Roentgenol 2013; 200 (02) 447-450
• 20 Pusceddu C, Fancellu A, Ballicu N, Fele RM, Sotgia B, Melis L. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol 2017; 46 (04) 539-545
• 21 Routt Jr ML, Simonian PT, Grujic L. The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions: a new technique. J Orthop Trauma 1995; 9 (01) 35-44
• 22 Fischer S, Vogl TJ, Marzi I. , et al. Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: single center experience in treating posterior pelvic instability. Eur J Radiol 2015; 84 (02) 290-294
• 23 Deschamps F, Farouil G, Hakime A, Teriitehau C, Barah A, de Baere T. Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol 2012; 35 (06) 1428-1432
• 24 Garnon J, Koch G, Ramamurthy N. , et al. Percutaneous CT and fluoroscopy-guided screw fixation of pathological fractures in the shoulder girdle: technical report of 3 cases. Cardiovasc Intervent Radiol 2016; 39 (09) 1332-1338
• 25 Harrington KD. Impending pathologic fractures from metastatic malignancy: evaluation and management. Instr Course Lect 1986; 35: 357-381
• 26 Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res 1989; (249) 256-264
• 27 Cazzato RL, Garnon J, Tsoumakidou G. , et al. Percutaneous image-guided screws meditated osteosynthesis of impeding and pathological/insufficiency fractures of the femoral neck in non-surgical cancer patients. Eur J Radiol 2017; 90: 1-5
• 28 Mavrovi E, Pialat JB, Beji H, Kalenderian AC, Vaz G, Richioud B. Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur. Diagn Interv Imaging 2017; 98 (06) 483-489
• 29 Cazzato RL, Koch G, Buy X. , et al. Percutaneous image-guided screw fixation of bone lesions in cancer patients: double-centre analysis of outcomes including local evolution of the treated focus. Cardiovasc Intervent Radiol 2016; 39 (10) 1455-1463