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Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

In long bones, cementoplasty alone does not provide sufficient stability, which may cause secondary fractures. This study reviewed the safety and efficacy of reinforced cementoplasty (RC) (percutaneous internal fixation using dedicated spindles combined with cementoplasty) for unstable malignant lesions of the cervicotrochanteric region (CTR) of the proximal femur.

Methods

Eighteen consecutive patients (nine women [50%] and nine men [50%]; mean age 55.1 ± 16.2 years; range 22–85) underwent RC for 19 unstable lesions of the CTR (16/19 [84.2%] bone metastases, 3/19 [15.8%] multiple myeloma lesions). All the patients were considered unsuitable for surgery. Clinical outcome was judged with a mean follow-up of 8.8 ± 7.2 months (range 1–27). The primary endpoints were occurrence of secondary fractures during the follow-up period and local pain relief measured by a visual analogue scale (VAS).

Results

No secondary fracture occurred. Mean VAS improved from 5.9 ± 3.1 (range 0–10) to 2.3 ± 2.4 (range 0–7) at 1 month (p = 0.001) to 1.6 ± 1.7 (range 0-5) at final follow-up (p = 0.0002). One symptomatic cement pulmonary embolism was recorded.

Conclusion

RC is an original minimally invasive technique providing pain relief and effective bone stability for unstable malignant lesions of the cervicotrochanteric region in patients unsuitable for open surgery.

Key Points

• Reinforced cementoplasty (RC) combines intralesional spindling with cementoplasty.

• RC provides effective bone stability and pain relief.

• RC is a suitable minimally invasive option for patients in poor general condition.

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Abbreviations

AP:

Anteroposterior

CT:

Computed tomography

CTR:

Cervicotrochanteric region

ECOG:

Eastern Cooperative Oncology Group

IQR:

Interquartile range

MBD:

Metastatic bone disease

MM:

Multiple myeloma

MRI:

Magnetic resonance imaging

PC:

Percutaneous cementoplasty

PMMA:

Poly-methyl-methacrylate

RC:

Reinforced cementoplasty

VAS:

Visual analogue scale

WHO:

World Health Organization

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Acknowledgements

The authors thank Mr Pierre Grare for his kind assistance with the English editing of the manuscript.

The scientific guarantor of this publication is Jacques Chiras. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. The design of the study and its content were approved by our local Institutional Review Board. The need for patient informed consent for retrospective analyses of records and imaging data was waived. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Kévin Premat, Frédéric Clarençon, Évelyne Cormier & Jacques Chiras

  2. Paris VI University Pierre et Marie Curie, Paris, France

    Frédéric Clarençon, Vincent Degos & Jacques Chiras

  3. Department of Orthopaedic Surgery, Pitié-Salpêtrière Hospital, Paris, France

    Raphael Bonaccorsi

  4. Department of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France

    Vincent Degos

Authors
  1. Kévin Premat
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  2. Frédéric Clarençon
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  3. Raphael Bonaccorsi
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  4. Vincent Degos
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  5. Évelyne Cormier
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  6. Jacques Chiras
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Correspondence to Jacques Chiras.

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Premat, K., Clarençon, F., Bonaccorsi, R. et al. Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region. Eur Radiol 27, 3973–3982 (2017). https://doi.org/10.1007/s00330-017-4774-3

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  • DOI: https://doi.org/10.1007/s00330-017-4774-3

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