Purpose Percutaneous cement augmentation had been described for the treatment of the painful metastatic lesions of the spine and pelvic bones using standard vertebroplasty systems, usually with low viscosity cements, and has been associated with a higher percentage of leaks compared with benign fractures. The study was done to assess the safety, feasibility and clinical outcome of using a highly viscous cement injected using a hydrolic based device in the treatment of metastatic lesions of the spine and pelvis using fluoroscopy and CT guidance.
Material and method A series of 17 consecutively treated patients with different types of different primary and secondary tumors were identified for the review. There were a total of 29 lesions treated. Levels treated ranged from C7 to L5, sacrum, ilium and ischium. The degree of leakage was assessed at each treated level using a strict 4 point scale (none, minimal, moderate, severe). The pattern of any observed leakage was also characterized as: discal, venous, paravetebral, epidural or SI joint. Cement leaks were assessed using both plain films and CT. Visual analog score (VAS) for pain was collected before the procedure and within 2–4 weeks after.
Results On plain film there was no leak at 13, minimal at 9 and moderate at 2 levels. On CT there was no leak in 4, minimal at 15 and moderate at 2 levels. CT imaging identified 10 additional minimal leaks but did not identify any additional moderate or severe leaks.
VAS pain data were available pre and post-procedure for 10/17 patients. Mean VAS pain score improved 49% from a mean preoperative score of 8.2 to a mean postoperative VAS of 4.2.
Conclusions Percutaneous cement augmentation of metastatic lesions of the spine and pelvis is feasible and safe using a high viscosity cement system. A hydrolic injection device allows more control over the injected cement into a small caliber needles. Cement augmentation results in pain relief, as measured by VAS, with a 49% decrease in pain score.
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Competing interests BG—DePuy Spine, Arthrocare Spine, Spine Alien, Ossoen LLC, Dfine.