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Percutaneous sacroplasty for sacral metastatic tumors under fluoroscopic guidance only.

Zhang J, Wu CG, Gu YF, Li MH - Korean J Radiol (2008 Nov-Dec)

Bottom Line: Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond.The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms.No other peri-procedural complications were observed for either patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road Shanghai, China.

ABSTRACT
Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.

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62-year-old man with metastasis at T12, L1, L2, L3, and S1 level from lymphoma.A, B. Sagittal CT (A) shows mixed sclerotic and poorly marinated low attenuation lesion in S1. Sagittal T2-weighted with fat saturated MR image (B) shows high band-like signal at periphery and iso-to-low signal in central portion of lesion.C. Transaxial schematic drawing demonstrates that trans-sacroiliac joint approach and positioning of 13-gauge bevel-edge needle is recommended for sacroplasties. Needle courses ilium, sacroiliac joint and sacral pedicle to center of lesion. Rotating needle to aim bevel-edge needle toward nerve root is recommended to avoid injury.D, E. Lateral (D) and anteroposterior (E) fluoroscopic versions reveal location of needle tip in lesion.F, G. Lateral (F) and anteroposterior (G) post-operative fluoroscopic views show equal distribution of cement with no cement migration and leakage at T12, L1, L2, L3, and S1.
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Figure 1: 62-year-old man with metastasis at T12, L1, L2, L3, and S1 level from lymphoma.A, B. Sagittal CT (A) shows mixed sclerotic and poorly marinated low attenuation lesion in S1. Sagittal T2-weighted with fat saturated MR image (B) shows high band-like signal at periphery and iso-to-low signal in central portion of lesion.C. Transaxial schematic drawing demonstrates that trans-sacroiliac joint approach and positioning of 13-gauge bevel-edge needle is recommended for sacroplasties. Needle courses ilium, sacroiliac joint and sacral pedicle to center of lesion. Rotating needle to aim bevel-edge needle toward nerve root is recommended to avoid injury.D, E. Lateral (D) and anteroposterior (E) fluoroscopic versions reveal location of needle tip in lesion.F, G. Lateral (F) and anteroposterior (G) post-operative fluoroscopic views show equal distribution of cement with no cement migration and leakage at T12, L1, L2, L3, and S1.

Mentions: A 62-year-old man affected by lymphoma with known skeletal metastases, was referred to our department with symptoms of refractory pain after non-operative therapy, which included chemotherapy, local radiotherapy, and opioid treatment. A month prior to the referral, the patient was admitted for a vertebroplasty for the T12, L1, L2 and L3 due to severe low back pain. The operation was significantly relieved from pain; however, the lower back pain progressively returned over the course of a month. Lumbosacral magnetic resonance imaging (MRI) and CT examinations (Fig. 1A, B) revealed an S1 mixed lesion. The patient had no weakness or neurosensory deficit.


Percutaneous sacroplasty for sacral metastatic tumors under fluoroscopic guidance only.

Zhang J, Wu CG, Gu YF, Li MH - Korean J Radiol (2008 Nov-Dec)

62-year-old man with metastasis at T12, L1, L2, L3, and S1 level from lymphoma.A, B. Sagittal CT (A) shows mixed sclerotic and poorly marinated low attenuation lesion in S1. Sagittal T2-weighted with fat saturated MR image (B) shows high band-like signal at periphery and iso-to-low signal in central portion of lesion.C. Transaxial schematic drawing demonstrates that trans-sacroiliac joint approach and positioning of 13-gauge bevel-edge needle is recommended for sacroplasties. Needle courses ilium, sacroiliac joint and sacral pedicle to center of lesion. Rotating needle to aim bevel-edge needle toward nerve root is recommended to avoid injury.D, E. Lateral (D) and anteroposterior (E) fluoroscopic versions reveal location of needle tip in lesion.F, G. Lateral (F) and anteroposterior (G) post-operative fluoroscopic views show equal distribution of cement with no cement migration and leakage at T12, L1, L2, L3, and S1.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627246&req=5

Figure 1: 62-year-old man with metastasis at T12, L1, L2, L3, and S1 level from lymphoma.A, B. Sagittal CT (A) shows mixed sclerotic and poorly marinated low attenuation lesion in S1. Sagittal T2-weighted with fat saturated MR image (B) shows high band-like signal at periphery and iso-to-low signal in central portion of lesion.C. Transaxial schematic drawing demonstrates that trans-sacroiliac joint approach and positioning of 13-gauge bevel-edge needle is recommended for sacroplasties. Needle courses ilium, sacroiliac joint and sacral pedicle to center of lesion. Rotating needle to aim bevel-edge needle toward nerve root is recommended to avoid injury.D, E. Lateral (D) and anteroposterior (E) fluoroscopic versions reveal location of needle tip in lesion.F, G. Lateral (F) and anteroposterior (G) post-operative fluoroscopic views show equal distribution of cement with no cement migration and leakage at T12, L1, L2, L3, and S1.
Mentions: A 62-year-old man affected by lymphoma with known skeletal metastases, was referred to our department with symptoms of refractory pain after non-operative therapy, which included chemotherapy, local radiotherapy, and opioid treatment. A month prior to the referral, the patient was admitted for a vertebroplasty for the T12, L1, L2 and L3 due to severe low back pain. The operation was significantly relieved from pain; however, the lower back pain progressively returned over the course of a month. Lumbosacral magnetic resonance imaging (MRI) and CT examinations (Fig. 1A, B) revealed an S1 mixed lesion. The patient had no weakness or neurosensory deficit.

Bottom Line: Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond.The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms.No other peri-procedural complications were observed for either patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road Shanghai, China.

ABSTRACT
Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.

Show MeSH
Related in: MedlinePlus