Sacroplasty with or Without Screw Fixation for Sacral Metastatic Tumors

Overview

Journal Front Oncol

Specialty Oncology

Date 2025 Mar 13

PMID 40078184

Authors

Evan P Cox

Sean Tutton

Matthew Scheidt

Brandon M Key

John C Neilson

Adam N Wooldridge

Meena Bedi

Donald A Hackbarth

David M King

Affiliations

Soon will be listed here.

Abstract

Introduction: Cementation (sacroplasty) with or without ablation has been shown to improve pain and function for patients with sacral metastatic disease. Percutaneous screw fixation with sacroplasty (PSFS) may provide superior outcomes in select patients.

Methods: Thirty patients with sacral metastases who underwent sacroplasty with or without ablation and screw fixation at a single institution were retrospectively reviewed. Patients were compared based on treatment (PSFS or sacroplasty alone) and fracture status (pathological or impending) with an ANCOVA. Traumatic fractures were excluded. Patients were followed for 4.4 months on average (range, 2 weeks to 36.5 months). Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score. The rate of secondary procedures as well as changes in narcotic usage were noted.

Results: Patients with pathological fractures who underwent PSFS demonstrated increased postoperative MSTS scores compared to those who underwent sacroplasty (51% ± 19 versus 25% ± 13, p = 0.005). Patients with impending pathological fractures who underwent PSFS did not demonstrate statistically significant increased postoperative MSTS scores compared to those who underwent sacroplasty alone (38% ± 17 versus 32% ± 12, p = 0.72).

Discussion: PSFS may provide additional benefit for patients with pathological fractures, while sacroplasty alone may be sufficient for those with impending pathologic fractures secondary to sacral metastatic disease. This study was limited by its retrospective design and sample size; however, the results may aid in treatment indications for sacral metastases and guide further research Level III, Therapeutic Study.

References

Tian Q, -Han K, Wang T, Min D, Wu C . Percutaneous Sacroplasty with or without Radiofrequency Ablation for Treatment of Painful Sacral Metastases. AJNR Am J Neuroradiol. 2022; 43(8):1222-1227. PMC: 9575424. DOI: 10.3174/ajnr.A7587. View

Balling H . Navigated Transsacral Screw Fixation for the Treatment of Bilateral Sacral Insufficiency Fractures. Clin Spine Surg. 2021; 34(8):286-290. DOI: 10.1097/BSD.0000000000001226. View

Pusceddu C, Fancellu A, Ballicu N, Fele R, Sotgia B, Melis L . CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol. 2017; 46(4):539-545. DOI: 10.1007/s00256-017-2584-y. View

Sun M, Zuo D, Wang H, Sheng J, Ma X, Wang C . Surgical Treatment of Sacral Metastatic Tumors. Front Oncol. 2021; 11:640933. PMC: 8267802. DOI: 10.3389/fonc.2021.640933. View

Quraishi N, Giannoulis K, Edwards K, Boszczyk B . Management of metastatic sacral tumours. Eur Spine J. 2012; 21(10):1984-93. PMC: 3463705. DOI: 10.1007/s00586-012-2394-9. View

Zhang J, Wu C, Gu Y, Li M . Percutaneous sacroplasty for sacral metastatic tumors under fluoroscopic guidance only. Korean J Radiol. 2008; 9(6):572-6. PMC: 2627246. DOI: 10.3348/kjr.2008.9.6.572. View

Tjardes T, Paffrath T, Baethis H, Shafizadeh S, Steinhausen E, Steinbuechel T . Computer assisted percutaneous placement of augmented iliosacral screws: a reasonable alternative to sacroplasty. Spine (Phila Pa 1976). 2008; 33(13):1497-500. DOI: 10.1097/BRS.0b013e318175c25c. View

Moussazadeh N, Laufer I, Werner T, Krol G, Boland P, Bilsky M . Sacroplasty for cancer-associated insufficiency fractures. Neurosurgery. 2015; 76(4):446-50. DOI: 10.1227/NEU.0000000000000658. View

ENNEKING W, Dunham W, Gebhardt M, Malawar M, Pritchard D . A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993; (286):241-6. View

10.

Smith H, Yuan P, Sasso R, Papadopolous S, Vaccaro A . An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws. Spine (Phila Pa 1976). 2006; 31(2):234-8. DOI: 10.1097/01.brs.0000194788.45002.1b. View

11.

Trumm C, Rubenbauer B, Piltz S, Reiser M, Hoffmann R . Screw placement and osteoplasty under computed tomographic-fluoroscopic guidance in a case of advanced metastatic destruction of the iliosacral joint. Cardiovasc Intervent Radiol. 2009; 34 Suppl 2:S288-93. DOI: 10.1007/s00270-009-9716-2. View

12.

Konig M, Hediger S, Schmitt J, Jentzsch T, Sprengel K, Werner C . In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock. Eur J Trauma Emerg Surg. 2016; 44(2):203-210. DOI: 10.1007/s00068-016-0681-6. View

13.

Dehdashti A, Martin J, Jean B, Rufenacht D . PMMA cementoplasty in symptomatic metastatic lesions of the S1 vertebral body. Cardiovasc Intervent Radiol. 2000; 23(3):235-7. DOI: 10.1007/s002700010052. View

14.

Papanastassiou I, Setzer M, Eleraky M, Baaj A, Nam T, Binitie O . Minimally invasive sacroiliac fixation in oncologic patients with sacral insufficiency fractures using a fluoroscopy-based navigation system. J Spinal Disord Tech. 2010; 24(2):76-82. DOI: 10.1097/BSD.0b013e3181df8e6b. View

15.

Kortman K, Ortiz O, Miller T, Brook A, Tutton S, Mathis J . Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions. J Neurointerv Surg. 2012; 5(5):461-6. DOI: 10.1136/neurintsurg-2012-010347. View

16.

Madaelil T, Wallace A, Jennings J . Radiofrequency ablation alone or in combination with cementoplasty for local control and pain palliation of sacral metastases: preliminary results in 11 patients. Skeletal Radiol. 2016; 45(9):1213-9. DOI: 10.1007/s00256-016-2404-9. View

17.

Cazzato R, Koch G, Buy X, Ramamurthy N, Tsoumakidou G, Caudrelier J . 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):1455-63. DOI: 10.1007/s00270-016-1389-z. View