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      Percutaneous cementoplasty for painful osteolytic distal femur metastases: a case report

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          Abstract

          Percutaneous cementoplasty has been shown to immediately restore the mechanical stability of affected bones, prevent further risk of bone fractures, and allow immediate weight bearing. It is emerging as one of the most promising procedures for patients with painful bone metastasis who are unsuitable for surgery or who show resistance to radiotherapy and/or analgesic therapies. This study aimed at describing the procedure, indications, and benefits of percutaneous cementoplasty for painful osteolytic distal femur metastases. We report the case of a painful metastatic lesion in the left distal femur secondary to non-small-cell lung cancer in a 58-year-old woman. The patient underwent percutaneous cementoplasty and experienced effective pain relief and recovery of knee function postoperatively. In addition, no perioperative complication was observed. Percutaneous cementoplasty for osteolytic distal femur metastases offers effective pain relief and restores impaired knee function. Although this method may be a safe option, larger samples of retrospective or prospective confirmation are warranted.

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          Most cited references 20

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          Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial.

          Non-randomised trials have reported benefits of kyphoplasty in patients with cancer and vertebral compression fractures (VCFs). We aimed to assess the efficacy and safety of balloon kyphoplasty compared with non-surgical management for patients with cancer who have painful VCFs. The Cancer Patient Fracture Evaluation (CAFE) study was a randomised controlled trial at 22 sites in Europe, the USA, Canada, and Australia. We enrolled patients aged at least 21 years who had cancer and one to three painful VCFs. Patients were randomly assigned by a computer-generated minimisation randomisation algorithm to kyphoplasty or non-surgical management (control group). Investigators and patients were not masked to treatment allocation. The primary endpoint was back-specific functional status measured by the Roland-Morris disability questionnaire (RDQ) score at 1 month. Outcomes at 1 month were analysed by modified intention to treat, including all patients with data available at baseline and at 1 month follow-up. Patients in the control group were allowed to crossover to receive kyphoplasty after 1 month. This study is registered with ClinicalTrials.gov, NCT00211237. Between May 16, 2005, and March 11, 2008, 134 patients were enrolled and randomly assigned to kyphoplasty (n=70) or non-surgical management (n=64). 65 patients in the kyphoplasty group and 52 in the control group had data available at 1 month. The mean RDQ score in the kyphoplasty group changed from 17·6 at baseline to 9·1 at 1 month (mean change -8·3 points, 95% CI -6·4 to -10·2; p<0·0001). The mean score in the control group changed from 18·2 to 18·0 (mean change 0·1 points; 95% CI -0·8 to 1·0; p=0·83). At 1 month, the kyphoplasty treatment effect for RDQ was -8·4 points (95% CI -7·6 to -9·2; p<0·0001). The most common adverse events within the first month were back pain (four of 70 in the kyphoplasty group and five of 64 in the control group) and symptomatic vertebral fracture (two and three, respectively). One patient in the kyphoplasty group had an intraoperative non-Q-wave myocardial infarction, which resolved and was attributed to anaesthesia. Another patient in this group had a new VCF, which was thought to be device related. For painful VCFs in patients with cancer, kyphoplasty is an effective and safe treatment that rapidly reduces pain and improves function. Medtronic Spine LLC. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Bone metastasis, skeletal-related events, and mortality in lung cancer patients: a Danish population-based cohort study.

            To estimate the incidence rate of bone metastasis and subsequent skeletal-related events (SREs) (radiation to bone, spinal cord compression, fracture, and surgery to bone) in lung cancer patients and to quantify their impact on mortality.
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              Temperature elevation caused by bone cement polymerization during vertebroplasty.

              Percutaneous vertebroplasty (PVP), whereby polymethylmethacrylate cement is injected into the vertebral body (VB), has been used to successfully treat various spinal lesions. The mechanism responsible for the palliative effect of PVP is unknown, but it may be the result of neural damage caused by heat liberated during polymerization of the polymethylmethacrylate. The purpose of the current study was to measure in vitro temperature histories at three key locations (anterior cortex, center, spinal canal) in VBs injected with one of two different bone cements (Simplex P and Orthocomp) to determine the role temperature plays in PVP. Twelve VBs (T11-L2) from three elderly female spines were instrumented with thermocouples and injected with 10 cc of one of the two cements. Temperatures were measured with the VBs in a bath (37 degrees C) for 15 min after injection. A Student's paired t-test was used to determine differences in peak temperature and time above 50 degrees C between the two cement groups. Peak temperatures and temperatures above 50 degrees C were significantly higher and longer, respectively, at the center of VBs injected with Simplex P (61.8 +/- 12.7 degrees C; 3.6 +/- 2.1 min) than those injected with Orthocomp (51.2 +/- 6.2 degrees C; 1.3 +/- 1.4 min). There was no significant difference in peak temperature between cements at the spinal canal location; temperature there did not rise above 41 degrees C. Although thermal damage to intraosseous neural tissue caused by cement polymerization cannot be ruled out as a potential mechanism for pain relief experienced by patients subsequent to PVP, it seems unlikely based on the worst-case conditions tested in the current study.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2016
                19 October 2016
                : 9
                : 859-863
                Affiliations
                [1 ]Department of Orthopedic Surgery
                [2 ]Department of Pulmonary Neoplasms Internal Medicine, The Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People’s Republic of China
                Author notes
                Correspondence: Yaosheng Liu; Shubin Liu, Department of Orthopedic Surgery, The Affiliated Hospital of Academy of Military Medical Sciences, No. 8, Fengtaidongda Rd, Beijing 100071, People’s Republic of China, Tel +86 010 6694 7317, Fax +86 010 6694 7317, Email 632763246@ 123456qq.com ; lsb9126@ 123456126.com
                Article
                jpr-9-859
                10.2147/JPR.S116035
                5077242
                © 2016 Lei et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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