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Rofo 2014; 186(9): 881-886
DOI: 10.1055/s-0033-1356418
Interventional Radiology
© Georg Thieme Verlag KG Stuttgart · New York

Balloon Sacroplasty as a Palliative Pain Treatment in Patients with Metastasis-Induced Bone Destruction and Pathological Fractures

Ballonsakroplastie als palliative Schmerztherapie bei Patienten mit metastasenbedingten ossären Destruktionen und pathologischen Frakturen
R. Andresen
1   Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide
,
S. Radmer
2   Orthopedic Surgery and Traumatology, Center of Orthopedics, Berlin
,
C. W. Lüdtke
1   Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide
,
P. Kamusella
1   Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide
,
C. Wissgott
1   Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide
,
H. C. Schober
3   Department of Internal Medicine, Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock
› Author Affiliations
Further Information

Publication History

07 May 2013

14 December 2013

Publication Date:
20 February 2014 (online)

Also available at
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Abstract

Purpose: In the case of metastatic involvement of the sacrum with destruction and consecutive pathological fracture, intense disabling pain is one of the defining factors. The feasibility, safety and pain development with cement augmentation were to be investigated.

Materials and Methods: CT-guided balloon sacroplasty was conducted in 10 patients with metastasis-induced bone destruction of the sacrum. After establishment of the entry point, a K-wire was first introduced as far as the central tumor lesion via the short, or transiliac axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times. The PMMA cement was then injected into the preformed cavity. The procedure was completed by a spiral CT control using the thin-slice technique. Pain intensity was determined using a visual analog scale (VAS) before the procedure, on the 2nd postoperative day and 6 months after the intervention. Finally, the patients were asked to state how satisfied they were.

Results: Balloon sacroplasty was technically feasible in all patients. The control CT scan showed central distribution of the cement in the tumor lesion. On average 6 +/– 1.78 (4 – 10) ml of PMMA cement were introduced per treated lesion. A significant (p < 0.001) reduction in pain according to the VAS occurred in all patients from 9.3 +/– 0.67 (8 – 10) pre-operatively to 2.7 +/– 1.28 (1 – 5) on the 2nd postoperative day and 2.9 +/– 0.81 (2 – 5) 6 months after the intervention. All of the patients were re-mobilized after the procedure and underwent the further therapeutic measures as planned.

Conclusion: Balloon sacroplasty is a helpful therapeutic option in the overall palliative treatment of patients with tumor-induced destruction. It is a safe and practicable procedure that markedly reduces disabling pain.

Key points:

• Balloon sacroplaty is a safe method of cement augmentation for osseous destruction

• With balloon sacroplasty debilitating lower back pain can be significantly reduced

• Balloon sacroplasty is a helpful supplement in palliative therapy

Citation Format:

• Andresen R, Radmer S, Lüdtke CW et al. Balloon Sacroplasty as a Palliative Pain Treatment in Patients with Metastasis-Induced Bone Destruction and Pathological Fractures. Fortschr Röntgenstr 2014; 186: 881 – 886

Zusammenfassung

Ziel: Bei einem Metastasenbefall des Os sacrum mit Destruktion und konsekutiver pathologischer Fraktur, stehen stärkste invalidisierende Schmerzen im Vordergrund. Es sollte die Durchführbarkeit, Sicherheit und Schmerzentwicklung einer Zementaugmentation überprüft werden.

Material und Methoden: Bei 10 Patienten mit einer metastasenbedingten ossären Destruktion des Os sacrum wurde eine CT-gesteuerte Ballonsakroplastie durchgeführt. Nach Festlegung der Eingangsebene erfolgte das Vorbringen eines Kirschner-Drahts bis in die zentrale Tumorläsion über die kurze- oder transiliakale Achse. Über den Draht wurde dann eine Hohlnadel eingebracht. Hierüber wurde ein Ballonkatheter eingeführt und unter CT-Kontrolle mehrmals in- und deflatiert. In den vorgefertigten Hohlraum erfolgte dann die PMMA-Zementapplikation. Den Abschluss der Intervention bildete eine Spiral-CT-Kontrolle in Dünnschichttechnik. Die Schmerzintensität wurde vor der Intervention, am 2. postoperativen Tag und 6 Monate post interventionem mittels visueller Analogskala (VAS) bestimmt. Abschließend wurde die Patientenzufriedenheit erfragt.

Ergebnisse: Bei allen Patienten ließ sich die Ballonsakroplastie technisch gut durchführen. Es zeigte sich im Kontroll-CT eine zentrale Zementverteilung in der Tumorläsion. Im Durchschnitt wurden pro versorgter Läsion 6 +/– 1,78 (4 – 10) ml PMMA-Zement eingebracht. Bei allen Patienten fand sich eine signifikante (p < 0,001) Schmerzreduktion nach VAS von 9,3 +/– 0,67 (8 – 10) präinterventionell auf 2,7 +/– 1,28 (1 – 5) am 2. postoperativen Tag und auf 2,9 +/– 0,81 (2 – 5) 6 Monate post interventionem. Alle Patienten konnten nach der Intervention remobilisiert und den weiter geplanten therapeutischen Maßnahmen zugeführt werden.

Schlussfolgerung: Die Ballonsakroplastie ist zur Behandlung von Patienten mit tumorbedingten Destruktionen eine hilfreiche Therapieoption im palliativen Gesamtkonzept. Sie ist eine sichere und gut durchführbare Prozedur, welche die invalidisierenden Schmerzen deutlich reduziert.

Kernaussagen:

• Die Ballonsakroplastie ist bei ossären Destruktionen ein sicheres Verfahren zur Zementaugmentation

• Mit der Ballonsakroplastie lassen sich invalidisierende Kreuzschmerzen signifikant reduzieren

• Die Ballonskroplastie ist eine hilfreiche Therapieergänzung im palliativen Gesamtkonzept

Key words

balloon sacroplasty - metastasis-induced bone destruction - interventional pain therapy - palliative therapy - os sacrum
 

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