Sacroplasty and iliac osteoplasty under combined CT and fluoroscopic guidance

Study Design. We postulate that osteoplasty of osteolytic metastases of the pelvic region performed by computed tomography (CT)-guided insertion of Kirschner wires into the lesions is effective and more feasible. Objective. To determine whether osteoplasty of osteolytic metastases of the pelvic region can be performed by a more feasible lesion access, increasing patient compliance and reducing patient radiation exposure. Summary of Background Data. Treatment of osteolytic bone metastases is palliative and relies mainly on the elimination of pain. When pain is medically intractable, this can be effectively treated by osteoplasty. Materials and Methods. A 61-year-old man with medically intractable pain from osteolytic lesions of the sacral ala and left iliac alum from pulmonary adenocarcinoma underwent osteoplasty. The lesions were accessed using Kirschner wires under CT guidance. Subsequently, under high-resolution fluoroscopic guidance, 13-G biopsy needles were advanced coaxially over the Kirschner wires and polymethyl methacrylate (PMMA) was injected into the lesions. Results. No peri-procedural complications were observed. The patient experienced an immediate and substantial pain relief that was persistent during a 4-month follow-up. Conclusions. This technique is safe and effective and requires fewer CT scans, thus reducing the patient's radiation exposure. The shorter procedure correlates to a better patient tolerance.