Korean J Radiol.  2008 Dec;9(6):572-576. 10.3348/kjr.2008.9.6.572.

Percutaneous Sacroplasty for Sacral Metastatic Tumors Under Fluoroscopic Guidance Only

• Zhang J
• Wu CG
• Gu YF
• Li MH

• KMID: 1118882
• DOI: http://doi.org/10.3348/kjr.2008.9.6.572

Abstract

Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.

Keyword

Metastatic tumors, sacroplasty; Interventional procedure technology

MeSH Terms

Adult
Bone Cements/*therapeutic use
Female
*Fluoroscopy
Humans
Injections, Intralesional
Male
Middle Aged
Pain, Intractable/etiology/*therapy
Polymethyl Methacrylate/administration & dosage
*Radiography, Interventional
*Sacrum
Spinal Neoplasms/complications/radiography/*secondary
*Vertebroplasty/methods

Figure

• 

  Fig. 1 62-year-old man with metastasis at T12, L1, L2, L3, and S1 level from lymphoma. A, B. Sagittal CT (A) shows mixed sclerotic and poorly marinated low attenuation lesion in S1. Sagittal T2-weighted with fat saturated MR image (B) shows high band-like signal at periphery and iso-to-low signal in central portion of lesion. C. Transaxial schematic drawing demonstrates that trans-sacroiliac joint approach and positioning of 13-gauge bevel-edge needle is recommended for sacroplasties. Needle courses ilium, sacroiliac joint and sacral pedicle to center of lesion. Rotating needle to aim bevel-edge needle toward nerve root is recommended to avoid injury. D, E. Lateral (D) and anteroposterior (E) fluoroscopic versions reveal location of needle tip in lesion. F, G. Lateral (F) and anteroposterior (G) post-operative fluoroscopic views show equal distribution of cement with no cement migration and leakage at T12, L1, L2, L3, and S1.

• 

  Fig. 2 38-year-old woman with metastatic tumor at S1, originating from lung cancer. A, B. Sagittal T2-weighted with fat saturated MR imaging (A) shows abnormal signal at S1. Axial CT scan (B) demonstrates osteolytic change of S1, which is characterized by breakdown of peri-cortex of S1 and S1 foramen. C, D. Anteroposterior (C) and lateral (D) views of postoperative fluoroscopy shows no cement migration. In addition, there is little cement leakage from needle track (arrows). Patient had no significant symptoms.

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