Avoiding complications in percutaneous osteoplasty

Published:January 15, 2022DOI:
      Percutaneous osteoplasty techniques include cement injection either solely performed or in combination to hardware such as cannulated screws, peek implants or other metallic hardware including micro-needles and Kirschner wires. Depending on bone and local forces applied, fracture and osseous defect characteristics as well as symptoms and operator's preference percutaneous osteoplasty techniques include cementoplasty, fixation by internal cemented screw and augmented osteoplasty. Literature data support efficacy and safety of these techniques, focusing mainly on the minimal invasive nature of these approaches along with minimum overall morbidity and mortality and an impressive pain reduction effect. Percutaneous osteoplasty techniques in the peripheral skeleton are indicated for pain palliation or for prevention of impeding pathologic fractures. Although safe, osteoplasty techniques are not without risk of complications and adverse events. Complications are classified based either upon clinical impact or timing of occurrence; complications’ reviewing and grading should be performed on terms of a uniform and accurate reproducible and validated categorization system. Significant factors for avoiding complications in percutaneous osteoplasty techniques include proper training, patient- and lesion-tailored approach, high-quality imaging guidance, sterility as well as appropriate selection of technique and materials. The present article reports the possible complications of percutaneous osteoplasty techniques and reviews the prerequisites necessary for avoiding and managing these adverse events.


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        • Filippiadis DK
        • Tselikas L
        • Bazzocchi A
        • et al.
        Percutaneous management of cancer pain.
        Curr Oncol Rep. 2020; 22: 43
        • Garnon J
        • Meylheuc L
        • Cazzato RL
        • et al.
        Percutaneous extra-spinal cementoplasty in patients with cancer: a systematic review of procedural details and clinical outcomes.
        Diagn Interv Imaging. 2019; 100: 743-752
        • 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: 1311-1316
        • Cazzato RL
        • Garnon J
        • Shaygi B
        • et al.
        Percutaneous consolidation of bone metastases: strategies and techniques.
        Insights Imaging. 2019; 10: 14
        • Yevich S
        • Tselikas L
        • Kelekis A
        • et al.
        Percutaneous management of metastatic osseous disease.
        Chin Clin Oncol. 2019; 8: 62
        • Key BM
        • Scheidt MJ
        • Tutton SM.
        Advanced interventional pain management approach to neoplastic disease outside the spine.
        Tech Vasc Interv Radiol. 2020; 23100705
        • Assouline J
        • Tselikas L
        • Roux C
        • et al.
        Prophylactic percutaneous consolidation of large osteolytic tumors of the pelvic ring using fixation by internal cemented screws.
        Radiol Imaging Cancer. 2021; 3e200137
        • Dassa M
        • Roux C
        • Tselikas L
        • et al.
        Image-guided percutaneous fixation with internal cemented screws of impending femoral neck pathologic fractures in patients with metastatic cancer: safety, efficacy, and durability.
        Radiology. 2020; 297: 721-729
        • Moulin B
        • Tselikas L
        • De Baere T
        • et al.
        CT guidance assisted by electromagnetic navigation system for percutaneous fixation by internal cemented screws (FICS).
        Eur Radiol. 2020; 30: 943-949
        • Anselmetti GC
        • Manca A
        • Ortega C
        • et al.
        Treatment of extraspinal painful bone metastases with percutaneous cementoplasty: a prospective study of 50 patients.
        Cardiovasc Intervent Radiol. 2008; 31: 1165-1173
        • Leoni CJ
        • Potter JE
        • Rosen MP
        • et al.
        Classifying complications of interventional procedures: a survey of practicing radiologists.
        J Vasc Interv Radiol. 2001; 12: 55-59
        • Filippiadis DK
        • Binkert C
        • Pellerin O
        • et al.
        Cirse quality assurance document and standards for classification of complications: The CIRSE Classification system.
        Cardiovasc Intervent Radiol. 2017; 40: 1141-1146
        • Deschamps F
        • Yevich S
        • Gravel G
        • et al.
        Percutaneous fixation by internal cemented screw for the treatment of unstable osseous disease in cancer patients.
        Semin Intervent Radiol. 2018; 35: 238-247
        • Cornelis FH
        • Tselikas L
        • Carteret T
        • et al.
        A novel implant for the prophylactic treatment of impending pathological fractures of the proximal femur: results from a prospective, first-in-man study.
        Cardiovasc Intervent Radiol. 2017; 40: 1070-1076
        • Kelekis A
        • Filippiadis D
        • Anselmetti G
        • et al.
        Percutaneous augmented peripheral osteoplasty in long bones of oncologic patients for pain reduction and prevention of impeding pathologic fracture: the Rebar concept.
        Cardiovasc Intervent Radiol. 2016; 39: 90-96
        • Kirkpatrick DL.
        How to start an objective evaluation of your training program.
        J Am Society Train Dir. 1956; 10: 18-22
        • Harrington KD.
        The management of acetabular insufficiency secondary to metastatic malignant disease.
        J Bone Joint Surg Am. 1981; 63: 653-664
        • Mirels H.
        Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures.
        Clin Orthop Relat Res. 1989; 249: 256-264
        • Damron TA
        • Nazarian A
        • Entezari V
        • et al.
        CT-based structural rigidity analysis is more accurate than Mirels scoring for fracture prediction in metastatic femoral lesions.
        Clin Orthop Relat Res. 2016; 474: 643-651
        • Hadi M
        • Walker C
        • Desborough M
        • et al.
        CIRSE standards of practice on peri-operative anticoagulation management during Interventional Radiology procedures.
        Cardiovasc Intervent Radiol. 2021; 44: 523-536
        • Begemann PG.
        CT-guided interventions—indications, technique, pitfalls.
        in: Mahnken AH Ricke J CT- and MR-guided interventions in radiology. Springer Berlin Heidelberg, Berlin2009: 11-20
        • Yevich S
        • Odisio B
        • Sheth R
        • et al.
        Integrated CT-fluorscopy equipment: Improving the interventional radiology approach and patient experience for treatment of musculoskeletal malignancies.
        Semin intervent Radiol. 2018; 35: 229-237
        • Mokry A
        • Willmitzer F
        • Hostettler R
        • et al.
        Evaluation of a novel, patient-mounted system for CT-guided needle navigation-an ex vivo study.
        Neuroradiology. 2019; 61: 55-61
        • Schubert T
        • Jacob AL
        • Pansini M
        • et al.
        CT-guided interventions using a free-hand, optical tracking system: initial clinical experience.
        Cardiovasc Intervent Radiol. 2013; 36: 1055-1062
        • Putzer D
        • Arco D
        • Schamberger B
        • et al.
        Comparison of two electromagnetic navigation systems for CT-guided punctures: a phantom study.
        ROFO. 2016; 188: 470-478
        • Lea WB
        • Neilson JC
        • King DM
        • et al.
        Minimally invasive stabilization using screws and cement for pelvic metastases: technical considerations for the pelvic "Screw and Glue" technique.
        Semin Intervent Radiol. 2019; 36: 229-240
        • Yevich S
        • Tselikas L
        • Gravel G
        • et al.
        Percutaneous cement injection for the palliative treatment of osseous metastases: A technical review.
        Semin Intervent Radiol. 2018; 35: 268-280
        • 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: E332-E338
        • Kurup AN
        • Morris JM
        • Schmit GD
        • et al.
        Balloon-assisted osteoplasty of periacetabular tumors following percutaneous cryoablation.
        J Vasc Interv Radiol. 2015; 26: 588-594
        • Gjorgjievska Delov A
        • Farrou G
        • Bouhamama A
        • et al.
        Tumoral dissemination along the screw trajectory in percutaneous osteosynthesis and cementoplasty: a non-described complication.
        Cardiovasc Intervent Radiol. 2018; 41: 336-339