Percutaneous screw-reinforced cement osteoplasty for palliation of postremission pain in larger lytic sacro-acetabular iliac cavities

Abstract

We present 2 cases of palliative percutaneous screw fixation for refractory pain from periacetabular residual cavities, after clinical remission, from osteolytic iliac masses involving the cortices of the sacroiliac joint (SIJ). Two patients—1 with a treated 8 cm breast metastasis and another with a treated 14 cm plasmacytoma—were selected for osseous stabilization based on imaging criteria and physical signs of iliac deformability and SIJ dysfunction. Neither lesion exhibited active malignancy following systemic therapy or discrete fracture. Following computed tomography-guided screw fixation across the mass and SIJ, with surrounding cement osteoplasty, to reduce mechanical stress on abnormal bone, both patients reported pain resolution beyond 1-year. This technique may be a suitable palliation even for large treated pelvic metastastic cavities and in the absence of fracture. Keywords: Pain, Bone, Osteotomy, Cancer