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      Fluoroscopy-Guided Percutaneous Sacroplasty for Painful Metastases at the Sacral Ala

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          Abstract

          Objective

          Percutaneous sacroplasty (PSP) is widely used in the clinic for osteoporotic sacral insufficiency fractures; however, few reports have described the safety and effectiveness of PSP for painful sacral metastases at the sacral ala under fluoroscopy alone. We aimed to evaluate the safety and efficacy of fluoroscopy-guided PSP for painful metastases at the sacral ala.

          Patients and Methods

          Thirty-five consecutive patients (median age, 60.74 ± 12.74 years), with a total of 41 metastatic lesions at the sacral ala, were treated with PSP. The patients were followed up for periods ranging from 1 month to 30 months (average, 8.23 ± 6.75 months). The visual analog scale (VAS), Oswestry Disability Index (ODI), and Karnofsky Performance Scale (KPS) were used to evaluate pain, mobility, and quality of life before the procedure and at 3 days and 1, 3, 6, 12, and 18 months after the procedure.

          Results

          Technical success was achieved in all patients. The minimum follow-up duration was 1 month. The mean VAS scores declined significantly from 7.20 ± 0.93 before the procedure to 3.43 ± 1.38 by day 3 after the procedure, and was 3.13 ± 1.07 at 1 month, 3.17 ± 1.15 at 3 months, 2.91± 1.38 at 6 months, and 2.57 ± 1.51 at 12 months after the procedure (P < 0.001). After PSP, analgesic drug administration had been discontinued in 31 of 35 patients (88.57%). The ODI and KPS also changed after PSP, with significant differences between the baseline scores and those at each follow-up examination (P < 0.001). Extraosseous cement leakage occurred in 12 cases without any major clinical complications.

          Conclusion

          PSP is a safe and effective technique for the palliative treatment of painful metastases involving the sacral ala under fluoroscopic guidance alone. It can relieve pain, reduce disability, and improve function, and is associated with minimal complications.

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          Most cited references 19

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          Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology.

          Most patients with advanced cancer develop diverse symptoms that can limit the efficacy of pain treatment and undermine their quality of life. The present study surveys symptom prevalence, etiology and severity in 593 cancer patients treated by a pain service. Non-opioid analgesics, opioids and adjuvants were administered following the WHO-guidelines for cancer pain relief. Other symptoms were systematically treated by appropriate adjuvant drugs. Pain and symptom severity was measured daily by patient self-assessment; the physicians of the pain service assessed symptom etiology and the severity of confusion, coma and gastrointestinal obstruction at each visit. The patients were treated for an average period of 51 days. Efficacy of pain treatment was good in 70%, satisfactory in 16% and inadequate in 14% of patients. The initial treatment caused a significant reduction in the average number of symptoms from four to three. Prevalence and severity of anorexia, impaired activity, confusion, mood changes, insomnia, constipation, dyspepsia, dyspnoea, coughing, dysphagia and urinary symptoms were significantly reduced, those of sedation, other neuropsychiatric symptoms and dry mouth were significantly increased and those of coma, vertigo, diarrhea, nausea, vomiting, intestinal obstruction, erythema, pruritus and sweating remained unchanged. The most frequent symptoms were impaired activity (74% of days), mood changes (22%), constipation (23%), nausea (23%) and dry mouth (20%). The highest severity scores were associated with impaired activity, sedation, coma, intestinal obstruction, dysphagia and urinary symptoms. Of all 23 symptoms, only constipation, erythema and dry mouth were assessed as being most frequently caused by the analgesic regimen. In conclusion, the high prevalence and severity of many symptoms in far advanced cancer can be reduced, if pain treatment is combined with systematic symptom control. Nevertheless, general, neuropsychiatric and gastrointestinal symptoms are experienced during a major part of treatment time and pain relief was inadequate in 14% of patients. Cancer pain management has to be embedded in a frame of palliative care, taking all the possibilities of symptom management into consideration.
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            Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients.

            Spinal metastasis is the most commonly en-countered tumor of the spine and represents an ominous extension of neoplastic disease. Symptomatic spinal metastases produce a characteristic clinical syndrome beginning with local back or neck pain. All too often, the significance of presenting pain is not appreciated and correct diagnosis is delayed until more blatant manifestations of spinal cord or nerve root dysfunction are manifest. Pain is followed by weakness,numbness, and sphincter dysfunction. The natural history is one of relentless progression to complete and irreversible paralysis unless timely treatment is undertaken. Plain radiographs provide a simple and useful screening test. MRI is, however, the imaging method of choice, providing information concern-ing the level, location, and geometry of the spinal tumor as well as details concerning the bony integrity of the spine, particularly adjacent to a culpable tumor, all of which is essential to determine the management options and treatment strategies. Percutaneous image-guided biopsy is a useful test to establish a tissue diagnosis.
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              Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions.

              To assess the outcomes and safety after CT-guided percutaneous sacroplasty in patients with painful sacral insufficiency fractures or pathologic sacral lesions.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                16 January 2020
                2020
                : 13
                : 151-156
                Affiliations
                [1 ]Department of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine and Health Sciences , Shanghai 201306, People’s Republic of China
                Author notes
                Correspondence: Ying-Sheng Cheng; Chun-Gen Wu Department of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences , No. 222 West Third Road, Shanghai201306, People’s Republic of ChinaTel +8618917683588Fax +86021-38297739 Email chengyingsheng@hotmail.com; 649514608@qq.com
                Article
                193866
                10.2147/JPR.S193866
                6970629
                © 2020 Tian 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. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 1, References: 20, Pages: 6
                Categories
                Original Research

                Anesthesiology & Pain management

                percutaneous sacroplasty, metastases, sacral ala

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