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

Steven Yevich; Lambros Tselikas; Guillaume Gravel; Thierry de Baère; Frederic Deschamps

doi:10.1055/s-0038-1673418

Seminars in Interventional Radiology, Table of Contents

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

¹Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas

,

Lambros Tselikas

²Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France

,

Guillaume Gravel

²Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France

,

Thierry de Baère

²Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France

,

Frederic Deschamps

²Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France

› Author Affiliations

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

Full Text

References

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
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
3 Deschamps F, de Baere T. Cementoplasty of bone metastases. Diagn Interv Imaging 2012; 93 (09) 685-689
4 Anselmetti GC. Osteoplasty: percutaneous bone cement injection beyond the spine. Semin Intervent Radiol 2010; 27 (02) 199-208
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
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
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
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
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
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
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
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
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
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
15 Gangi A, Guth S, Imbert JP, Marin H, Dietemann JL. Percutaneous vertebroplasty: indications, technique, and results. Radiographics 2003; 23 (02) e10
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
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
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
19 Figura N, Smith J, Yu HM. Mechanisms of, and adjuvants for, bone pain. Hematol Oncol Clin North Am 2018; 32 (03) 447-458
20 Mundy GR. Mechanisms of bone metastasis. Cancer 1997; 80 (8, Suppl): 1546-1556
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
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
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
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
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
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
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
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
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
30 Laredo JD, Hamze B. Complications of percutaneous vertebroplasty and their prevention. Semin Ultrasound CT MR 2005; 26 (02) 65-80
31 Barragán-Campos HM, Vallée JN, Lo D. , et al. Percutaneous vertebroplasty for spinal metastases: complications. Radiology 2006; 238 (01) 354-362
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
33 Hidalgo JA, Reddy CG, Schmit GD, Spinner RJ. Sciatic neuropathy after extruded cement from cementoplasty. Spine J 2012; 12 (06) 532-533
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
35 Mirovsky Y, Anekstein Y, Shalmon E, Blankstein A, Peer A. Intradiscal cement leak following percutaneous vertebroplasty. Spine 2006; 31 (10) 1120-1124
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
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
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
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
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
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
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
43 Monticelli F, Meyer HJ, Tutsch-Bauer E. Fatal pulmonary cement embolism following percutaneous vertebroplasty (PVP). Forensic Sci Int 2005; 149 (01) 35-38
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
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
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
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
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
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
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
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
52 Mathis JM. Percutaneous vertebroplasty: complication avoidance and technique optimization. AJNR Am J Neuroradiol 2003; 24 (08) 1697-1706
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
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
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
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
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
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
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
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
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
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
63 Kosova E, Bergmark B, Piazza G. Fat embolism syndrome. Circulation 2015; 131 (03) 317-320
64 Uransilp N, Muengtaweepongsa S, Chanalithichai N, Tammachote N. Fat embolism syndrome: a case report and review of literature. Care Rep Med 2018;
65 Heini PF, Orler R. [Vertebroplasty in severe osteoporosis. Technique and experience with multi-segment injection]. Orthopade 2004; 33 (01) 22-30
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
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
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
69 Peebles DJ, Ellis RH, Stride SD, Simpson BR. Cardiovascular effects of methylmethacrylate cement. BMJ 1972; 1 (5796): 349-351
70 Jay B, Ahn SH. Vertebroplasty. Semin Intervent Radiol 2013; 30 (03) 297-306
71 Kasper DM. Kyphoplasty. Semin Intervent Radiol 2010; 27 (02) 172-184
72 Wang DT, Dubois M, Tutton SM. Complications in musculoskeletal intervention: important considerations. Semin Intervent Radiol 2015; 32 (02) 163-173