Moussazadeh Nelson, Laufer Ilya, Werner Timothy, Krol George, Boland Patrick, Bilsky Mark H, Lis Eric
*Division of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; ‡Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York; §Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; ¶Division of Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Neurosurgery. 2015 Apr;76(4):446-50; discussion 450. doi: 10.1227/NEU.0000000000000658.
Tumor-associated sacral insufficiency fractures (SIF) present a significant clinical challenge. As survival increases for many malignancies, sacral fractures associated with metastases, sacral or extended pelvic radiation, and paraneoplastic osteoporosis are increasingly common and yet remain difficult to treat in the setting of the potentially significant morbidity of open sacral surgery.
To describe our prospective experience with sacroplasty for tumor-associated lesions, including the largest series to date of radiation-induced SIF.
Twenty-five patients with symptomatic SIF underwent 31 percutaneous fluoroscopy-guided sacroplasties with a median 5.8 mL of polymethyl methacrylate or a ceramic-resin composite under fluoroscopic guidance and with concurrent biopsy acquisition. Eighteen patients had fractures related to previous sacral or pelvic radiation; 4 had viable lytic lesions; and 2 had oncology-related osteoporosis. Postoperative pain reduction, procedural morbidity, and functional outcomes were recorded.
Twenty of 25 patients (80%) had reduction in their visual analog pain score at a median follow-up of 6.5 months; no patients worsened. The mean visual analog scale score decreased from 8.8 to 4.7 postprocedurally (P < .001), with significant reductions regardless of the underlying pathology (P < .001 to P < .05). Six of 13 patients with pretreatment ambulatory impairment required fewer ambulatory aids and 3 were newly ambulatory. Extravertebral cement migration was noted in 18 procedures; however, no instance was clinically relevant. Six repeat or contralateral procedures were performed. No morbidity was encountered.
Sacroplasty is a safe and effective option for the palliation of sacral fractures in the oncologic population.
肿瘤相关性骶骨不全骨折（SIF）是一项重大的临床挑战。随着许多恶性肿瘤患者生存率的提高，与转移、骶骨或盆腔扩大放疗以及副肿瘤性骨质疏松相关的骶骨骨折越来越常见，但在开放性骶骨手术可能带来严重并发症的情况下，其治疗仍然困难。
描述我们对肿瘤相关性病变行骶骨成形术的前瞻性经验，包括迄今为止最大系列的放射性SIF。
25例有症状的SIF患者接受了31次经皮透视引导下的骶骨成形术，在透视引导下并同时获取活检标本，平均注入5.8 mL聚甲基丙烯酸甲酯或陶瓷树脂复合材料。18例患者的骨折与先前的骶骨或盆腔放疗有关；4例有活性溶骨性病变；2例有肿瘤相关性骨质疏松。记录术后疼痛减轻情况、手术并发症和功能结果。
25例患者中有20例（80%）在中位随访6.5个月时视觉模拟疼痛评分降低；无患者病情恶化。术后视觉模拟量表评分从8.8降至4.7（P <.001），无论潜在病理如何均有显著降低（P <.001至P <.05）。13例术前有行走障碍的患者中有6例需要的助行器减少，3例开始能够行走。18例手术中发现椎体外骨水泥迁移；然而，无1例具有临床相关性。进行了6次重复或对侧手术。未发生并发症。
骶骨成形术是缓解肿瘤患者骶骨骨折的一种安全有效的选择。
