Download PDF
Semin intervent Radiol 2018; 35(04): 268-280
DOI: 10.1055/s-0038-1673418
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Cement Injection for the Palliative Treatment of Osseous Metastases: A Technical Review

Steven Yevich
1   Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Lambros Tselikas
2   Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
,
Guillaume Gravel
2   Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
,
Thierry de Baère
2   Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
,
Frederic Deschamps
2   Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
› Author Affiliations
Further Information

Publication History

Publication Date:
05 November 2018 (online)

Also available at
    Permissions and Reprints

Abstract

The technical art to percutaneous injection of polymethyl methacrylate (PMMA) cement for the palliative treatment of osseous metastases is not without pitfalls. Pathologic fracture, cortical bone erosion, large lytic tumor, aggressive tumor biology, and tumor vascularity may increase the risk of cement leakage or limit complete consolidation. A calculated and determined approach is often necessary to achieve satisfactory patient-tailored results. This article reviews the challenges and potential complications during the consolidation of osseous metastases. Case examples are presented to facilitate early detection of impending cement leakage, minimize procedural risks, and provide management suggestions for complications. Technical pearls are provided to refine consolidative techniques and improve the comprehensive treatment of painful osseous metastases.

Keywords

cement leakage - cementoplasty - polymethyl methacrylate - complication - interventional radiology
 

  • References

  • 1 Li S, Peng Y, Weinhandl ED. , et al. Estimated number of prevalent cases of metastatic bone disease in the US adult population. Clin Epidemiol 2012; 4: 87-93
    PubMedGoogle Scholar
  • 2 Oster G, Lamerato L, Glass AG. , et al. Natural history of skeletal-related events in patients with breast, lung, or prostate cancer and metastases to bone: a 15-year study in two large US health systems. Support Care Cancer 2013; 21 (12) 3279-3286
    CrossrefPubMedGoogle Scholar
  • 3 Deschamps F, de Baere T. Cementoplasty of bone metastases. Diagn Interv Imaging 2012; 93 (09) 685-689
    CrossrefPubMedGoogle Scholar
  • 4 Anselmetti GC. Osteoplasty: percutaneous bone cement injection beyond the spine. Semin Intervent Radiol 2010; 27 (02) 199-208
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Deschamps F, Farouil G, Hakime A, Teriitehau C, Barah A, de Baere T. Percutaneous stabilization of impending pathological fracture of the proximal femur. Cardiovasc Intervent Radiol 2012; 35 (06) 1428-1432
    CrossrefPubMedGoogle Scholar
  • 6 Saad F, Lipton A, Cook R, Chen YM, Smith M, Coleman R. Pathologic fractures correlate with reduced survival in patients with malignant bone disease. Cancer 2007; 110 (08) 1860-1867
    CrossrefPubMedGoogle Scholar
  • 7 Weinfurt KP, Li Y, Castel LD. , et al. The impact of skeletal-related events on health-related quality of life in patients with metastatic prostate cancer. Ann Oncol 2002; 13 (Suppl. 05) 180
    PubMedGoogle Scholar
  • 8 Sathiakumar N, Delzell E, Morrisey MA. , et al. Mortality following bone metastasis and skeletal-related events among women with breast cancer: a population-based analysis of U.S. Medicare beneficiaries, 1999-2006. Breast Cancer Res Treat 2012; 131 (01) 231-238
    CrossrefPubMedGoogle Scholar
  • 9 Oefelein MG, Ricchiuti V, Conrad W, Resnick MI. Skeletal fractures negatively correlate with overall survival in men with prostate cancer. J Urol 2002; 168 (03) 1005-1007
    CrossrefPubMedGoogle Scholar
  • 10 Lage MJ, Barber BL, Harrison DJ, Jun S. The cost of treating skeletal-related events in patients with prostate cancer. Am J Manag Care 2008; 14 (05) 317-322
    PubMedGoogle Scholar
  • 11 Ruiz Santiago F, Santiago Chinchilla A, Guzmán Álvarez L, Pérez Abela AL, Castellano García MdelM, Pajares López M. Comparative review of vertebroplasty and kyphoplasty. World J Radiol 2014; 6 (06) 329-343
    CrossrefPubMedGoogle Scholar
  • 12 Berenson J, Pflugmacher R, Jarzem P. , et al; Cancer Patient Fracture Evaluation (CAFE) Investigators. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol 2011; 12 (03) 225-235
    CrossrefPubMedGoogle Scholar
  • 13 Anselmetti GC, Manca A, Ortega C, Grignani G, Debernardi F, Regge D. Treatment of extraspinal painful bone metastases with percutaneous cementoplasty: a prospective study of 50 patients. Cardiovasc Intervent Radiol 2008; 31 (06) 1165-1173
    CrossrefPubMedGoogle Scholar
  • 14 Chew C, Craig L, Edwards R, Moss J, O'Dwyer PJ. Safety and efficacy of percutaneous vertebroplasty in malignancy: a systematic review. Clin Radiol 2011; 66 (01) 63-72
    CrossrefPubMedGoogle Scholar
  • 15 Gangi A, Guth S, Imbert JP, Marin H, Dietemann JL. Percutaneous vertebroplasty: indications, technique, and results. Radiographics 2003; 23 (02) e10
    CrossrefPubMedGoogle Scholar
  • 16 Cazzato RL, Koch G, Buy X. , et al. Percutaneous image-guided screw fixation of bone lesions in cancer patients: double-centre analysis of outcomes including local evolution of the treated focus. Cardiovasc Intervent Radiol 2016; 39 (10) 1455-1463
    CrossrefPubMedGoogle Scholar
  • 17 Deschamps F, de Baere T, Hakime A. , et al. Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol 2016; 26 (06) 1631-1639
    CrossrefPubMedGoogle Scholar
  • 18 Deschamps F, Farouil G, Hakime A. , et al. Cementoplasty of metastases of the proximal femur: is it a safe palliative option?. J Vasc Interv Radiol 2012; 23 (10) 1311-1316
    CrossrefPubMedGoogle Scholar
  • 19 Figura N, Smith J, Yu HM. Mechanisms of, and adjuvants for, bone pain. Hematol Oncol Clin North Am 2018; 32 (03) 447-458
    CrossrefPubMedGoogle Scholar
  • 20 Mundy GR. Mechanisms of bone metastasis. Cancer 1997; 80 (8, Suppl): 1546-1556
    CrossrefPubMedGoogle Scholar
  • 21 Wallace AN, Greenwood TJ, Jennings JW. Radiofrequency ablation and vertebral augmentation for palliation of painful spinal metastases. J Neurooncol 2015; 124 (01) 111-118
    CrossrefPubMedGoogle Scholar
  • 22 Nakatsuka A, Yamakado K, Maeda M. , et al. Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol 2004; 15 (07) 707-712
    CrossrefPubMedGoogle Scholar
  • 23 Munk PL, Rashid F, Heran MK. , et al. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol 2009; 20 (07) 903-911
    CrossrefPubMedGoogle Scholar
  • 24 Hartung MP, Tutton SM, Hohenwalter EJ, King DM, Neilson JC. Safety and efficacy of minimally invasive acetabular stabilization for periacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol 2016; 27 (05) 682-688.e1
    CrossrefPubMedGoogle Scholar
  • 25 Trumm CG, Pahl A, Helmberger TK. , et al. CT fluoroscopy-guided percutaneous vertebroplasty in spinal malignancy: technical results, PMMA leakages, and complications in 202 patients. Skeletal Radiol 2012; 41 (11) 1391-1400
    CrossrefPubMedGoogle Scholar
  • 26 Pitton MB, Herber S, Koch U, Oberholzer K, Drees P, Düber C. CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures. Eur Radiol 2008; 18 (11) 2568-2578
    CrossrefPubMedGoogle Scholar
  • 27 Kurup AN, Schmit GD, Morris JM. , et al. Avoiding complications in bone and soft tissue ablation. Cardiovasc Intervent Radiol 2017; 40 (02) 166-176
    CrossrefPubMedGoogle Scholar
  • 28 Lee CH, Lee JW, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Needle-tract seeding after percutaneous vertebroplasty: a case report. Spine 2014; 39 (12) E752-E756
    CrossrefPubMedGoogle Scholar
  • 29 Chen YJ, Chang GC, Chen WH, Hsu HC, Lee TS. Local metastases along the tract of needle: a rare complication of vertebroplasty in treating spinal metastases. Spine 2007; 32 (21) E615-E618
    CrossrefPubMedGoogle Scholar
  • 30 Laredo JD, Hamze B. Complications of percutaneous vertebroplasty and their prevention. Semin Ultrasound CT MR 2005; 26 (02) 65-80
    CrossrefPubMedGoogle Scholar
  • 31 Barragán-Campos HM, Vallée JN, Lo D. , et al. Percutaneous vertebroplasty for spinal metastases: complications. Radiology 2006; 238 (01) 354-362
    CrossrefPubMedGoogle Scholar
  • 32 Corcos G, Dbjay J, Mastier C. , et al. Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors. Spine 2014; 39 (05) E332-E338
    CrossrefPubMedGoogle Scholar
  • 33 Hidalgo JA, Reddy CG, Schmit GD, Spinner RJ. Sciatic neuropathy after extruded cement from cementoplasty. Spine J 2012; 12 (06) 532-533
    CrossrefPubMedGoogle Scholar
  • 34 Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 2004; 25 (02) 175-180
    PubMedGoogle Scholar
  • 35 Mirovsky Y, Anekstein Y, Shalmon E, Blankstein A, Peer A. Intradiscal cement leak following percutaneous vertebroplasty. Spine 2006; 31 (10) 1120-1124
    CrossrefPubMedGoogle Scholar
  • 36 Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology 1996; 199 (01) 241-247
    CrossrefPubMedGoogle Scholar
  • 37 Venmans A, Klazen CA, Lohle PN. , et al. Percutaneous vertebroplasty and pulmonary cement embolism: results from VERTOS II. AJNR Am J Neuroradiol 2010; 31 (08) 1451-1453
    CrossrefPubMedGoogle Scholar
  • 38 Choe DH, Marom EM, Ahrar K, Truong MT, Madewell JE. Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty. AJR Am J Roentgenol 2004; 183 (04) 1097-1102
    CrossrefPubMedGoogle Scholar
  • 39 Vasconcelos C, Gailloud P, Beauchamp NJ, Heck DV, Murphy KJ. Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutives procedures. AJNR Am J Neuroradiol 2002; 23 (06) 913-917
    PubMedGoogle Scholar
  • 40 Tozzi P, Abdelmoumene Y, Corno AF, Gersbach PA, Hoogewoud HM, von Segesser LK. Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg 2002; 74 (05) 1706-1708
    CrossrefPubMedGoogle Scholar
  • 41 Padovani B, Kasriel O, Brunner P, Peretti-Viton P. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 1999; 20 (03) 375-377
    PubMedGoogle Scholar
  • 42 Chen HL, Wong CS, Ho ST, Chang FL, Hsu CH, Wu CT. A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg 2002; 95 (04) 1060-1062
    PubMedGoogle Scholar
  • 43 Monticelli F, Meyer HJ, Tutsch-Bauer E. Fatal pulmonary cement embolism following percutaneous vertebroplasty (PVP). Forensic Sci Int 2005; 149 (01) 35-38
    CrossrefPubMedGoogle Scholar
  • 44 Kim SY, Seo JB, Do KH, Lee JS, Song KS, Lim TH. Cardiac perforation caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJR Am J Roentgenol 2005; 185 (05) 1245-1247
    CrossrefPubMedGoogle Scholar
  • 45 Scroop R, Eskridge J, Britz GW. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report. AJNR Am J Neuroradiol 2002; 23 (05) 868-870
    PubMedGoogle Scholar
  • 46 Zhao Y, Liu T, Zheng Y, Wang L, Hao D. Successful percutaneous retrieval of a large pulmonary cement embolus caused by cement leakage during percutaneous vertebroplasty: case report and literature review. Spine 2014; 39 (26) E1616-E1621
    CrossrefPubMedGoogle Scholar
  • 47 Baumann A, Tauss J, Baumann G, Tomka M, Hessinger M, Tiesenhausen K. Cement embolization into the vena cava and pulmonal arteries after vertebroplasty: interdisciplinary management. Eur J Vasc Endovasc Surg 2006; 31 (05) 558-561
    CrossrefPubMedGoogle Scholar
  • 48 Krueger A, Bliemel C, Zettl R, Ruchholtz S. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J 2009; 18 (09) 1257-1265
    CrossrefPubMedGoogle Scholar
  • 49 Chung SE, Lee SH, Kim TH, Yoo KH, Jo BJ. Renal cement embolism during percutaneous vertebroplasty. Eur Spine J 2006; 15 (Suppl. 05) 590-594
    CrossrefPubMedGoogle Scholar
  • 50 Amoretti N, Hovorka I, Marcy PY, Grimaud A, Brunner P, Bruneton JN. Aortic embolism of cement: a rare complication of lumbar percutaneous vertebroplasty. Skeletal Radiol 2007; 36 (07) 685-687
    CrossrefPubMedGoogle Scholar
  • 51 Soultanis K, Kakisis JD, Pyrovolou N, Lazaris AM, Vasdekis S, Soukakos P. Peripheral arterial embolization of cement during revision spine surgery. Ann Vasc Surg 2009; 23 (03) 413.e9-413.e12
    PubMedGoogle Scholar
  • 52 Mathis JM. Percutaneous vertebroplasty: complication avoidance and technique optimization. AJNR Am J Neuroradiol 2003; 24 (08) 1697-1706
    PubMedGoogle Scholar
  • 53 Chen YJ, Chen HY, Lo DF, Chen HT, Hsu HC. Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty: a technical report. Spine J 2014; 14 (12) 3025-3029
    CrossrefPubMedGoogle Scholar
  • 54 Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine 2006; 31 (22) 2562-2568
    CrossrefPubMedGoogle Scholar
  • 55 Anselmetti GC, Zoarski G, Manca A. , et al. Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures. Cardiovasc Intervent Radiol 2008; 31 (05) 937-947
    CrossrefPubMedGoogle Scholar
  • 56 Kurup AN, Morris JM, Schmit GD. , et al. Balloon-assisted osteoplasty of periacetabular tumors following percutaneous cryoablation. J Vasc Interv Radiol 2015; 26 (04) 588-594
    CrossrefPubMedGoogle Scholar
  • 57 Uri IF, Garnon J, Tsoumakidou G, Gangi A. An ice block: a novel technique of successful prevention of cement leakage using an ice ball. Cardiovasc Intervent Radiol 2015; 38 (02) 470-474
    CrossrefPubMedGoogle Scholar
  • 58 Anselmetti GC, Manca A, Tutton S. , et al. Percutaneous vertebral augmentation assisted by PEEK implant in painful osteolytic vertebral metastasis involving the vertebral wall: experience on 40 patients. Pain Physician 2013; 16 (04) E397-E404
    PubMedGoogle Scholar
  • 59 Cornelis FH, Petitpierre F, Fabre T, Gille O, Amoretti N, Hauger O. Percutaneous low-pressure bone stenting to control cement deposition in extensive lytic lesions. Eur Radiol 2017; 27 (09) 3942-3946
    CrossrefPubMedGoogle Scholar
  • 60 Aebli N, Krebs J, Davis G, Walton M, Williams MJ, Theis JC. Fat embolism and acute hypotension during vertebroplasty: an experimental study in sheep. Spine 2002; 27 (05) 460-466
    CrossrefPubMedGoogle Scholar
  • 61 Ahmadzai H, Campbell S, Archis C, Clark WA. Fat embolism syndrome following percutaneous vertebroplasty: a case report. Spine J 2014; 14 (04) e1-e5
    CrossrefPubMedGoogle Scholar
  • 62 Syed MI, Jan S, Patel NA, Shaikh A, Marsh RA, Stewart RV. Fatal fat embolism after vertebroplasty: identification of the high-risk patient. AJNR Am J Neuroradiol 2006; 27 (02) 343-345
    PubMedGoogle Scholar
  • 63 Kosova E, Bergmark B, Piazza G. Fat embolism syndrome. Circulation 2015; 131 (03) 317-320
    CrossrefPubMedGoogle Scholar
  • 64 Uransilp N, Muengtaweepongsa S, Chanalithichai N, Tammachote N. Fat embolism syndrome: a case report and review of literature. Care Rep Med 2018; DOI: 10.1155/2018/1479850.
    CrossrefPubMedGoogle Scholar
  • 65 Heini PF, Orler R. [Vertebroplasty in severe osteoporosis. Technique and experience with multi-segment injection]. Orthopade 2004; 33 (01) 22-30
    CrossrefPubMedGoogle Scholar
  • 66 Hoppe S, Elfiky T, Keel MJ, Aghayev E, Ecker TM, Benneker LM. Lavage prior to vertebral augmentation reduces the risk for cement leakage. Eur Spine J 2016; 25 (11) 3463-3469
    CrossrefPubMedGoogle Scholar
  • 67 Vasconcelos C, Gailloud P, Martin JB, Murphy KJ. Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty. [letter] J Vasc Interv Radiol 2001; 12 (08) 1001-1002
    CrossrefPubMedGoogle Scholar
  • 68 Ahmed M, Bjurholm A, Kreicbergs A, Schultzberg M. Neuropeptide Y, tyrosine hydroxylase and vasoactive intestinal polypeptide-immunoreactive nerve fibers in the vertebral bodies, discs, dura mater, and spinal ligaments of the rat lumbar spine. Spine 1993; 18 (02) 268-273
    CrossrefPubMedGoogle Scholar
  • 69 Peebles DJ, Ellis RH, Stride SD, Simpson BR. Cardiovascular effects of methylmethacrylate cement. BMJ 1972; 1 (5796): 349-351
    CrossrefPubMedGoogle Scholar
  • 70 Jay B, Ahn SH. Vertebroplasty. Semin Intervent Radiol 2013; 30 (03) 297-306
    Article in Thieme ConnectPubMedGoogle Scholar
  • 71 Kasper DM. Kyphoplasty. Semin Intervent Radiol 2010; 27 (02) 172-184
    Article in Thieme ConnectPubMedGoogle Scholar
  • 72 Wang DT, Dubois M, Tutton SM. Complications in musculoskeletal intervention: important considerations. Semin Intervent Radiol 2015; 32 (02) 163-173
    Article in Thieme ConnectPubMedGoogle Scholar