Advancements in minimally invasive interventional oncology procedures for painful sacral metastases under imaging guidance
Objective: To examine percutaneous interventions for sacral metastases and present advancements in intra-operative imaging guidance. Methods: A single-institution, retrospective cohort review of 18 patients with cancer who underwent a combination of percutaneous ablation and cement augmentation for...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | EngMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950489924000514 |
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| Summary: | Objective: To examine percutaneous interventions for sacral metastases and present advancements in intra-operative imaging guidance. Methods: A single-institution, retrospective cohort review of 18 patients with cancer who underwent a combination of percutaneous ablation and cement augmentation for painful sacral metastases between 2019 and 2024 was conducted. The type of intra-operative image guidance and clinical improvement of pain and functional scores were analyzed at long-term follow-up (2 weeks, 3 months, 6 months, 12 months, and 24 months). Results: Primary cancers included the breast (n = 4), prostate (n = 3), and kidney (n = 2); multiple myeloma (n = 2); and melanoma (n = 2). The average age was 66.0 ± 11.8 years. Average follow-up was 15.4 ± 14.1 months, ranging from 2.9 to 41.8 months. The intra-operative imaging techniques included fluoroscopy only (n = 1), CT with fluoroscopy (n = 14), CT with fluoroscopy and O-arm navigation (n = 1), and CT with fluoroscopy and 3D segmentation (n = 2). Cement extravasation occurred in one fluoroscopy-guided case. Percutaneous intervention led to improvements in pain and functional scores compared to the preoperative baseline (2 weeks: 2.0 [IQR = 2.0], 3 months: 2.0 [IQR = 2.0], and 6 months: 2.0 [IQR = 3.0]). Pain and functional improvements were maintained compared to the preoperative baseline. Conclusion: Advancement of novel image guidance techniques, such as 3D segmentation, provides enhanced instrument guidance into the sacral defect areas and improves cement localization, reducing the risk of cement leakage through defective bones surrounding critical areas such as the neural foramen, canal, or lumbosacral plexus. |
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| ISSN: | 2950-4899 |