gms | German Medical Science

Objectives: To describe the surgical technique and assess the clinical use of a minimally invasive intramedullary polymer stabilization device cured with light(IlluminOss) for prophylactic fixation of the pelvis in cavitary and non-cavitary defects secondary to metastatic bone disease.

Methods: Ten consecutive metastatic pelvic bone disease patients were treated with this technique in a consecutive fashion by a single surgeon, single institution.

There were six female and four male patients, 69 years-old in average with a median of 72 years (R= 60-75).

Average and median BMI were 27.5 and 25.2, respectively (R= 19.9-47.5).

The most common primary tumor was non-small cell lung carcinoma (NSCLC).Average Charleston Comorbidity Index (CCI) was 6.8 (R= 6-10) while age-adjusted CCI averaged 10.3 (R=6-14). All patients were ASA index 3 or 4.

Most patients have already had radiation and/or chemotherapy treatments. 7/10 patients had visceral metastatic disease. All patients had cavitary and non-cavitary periacetabular lesions associated to pain and inability to bear weight due to impending pathologic fracture. All patients were treated with IlluminOss. Areas of stabilization included: the supra-acetabulum and sciatic buttress, the acetabular posterior column and/or the anterior acetabular column. Posterior iliosacral stabilization was additionally performed in patients with sacral involvement (Table 1 [Tab. 1]).

Results and Conclusion: In addition to the use of IlluminOss, two patients received femoral intramedullary carbon-fiber nail fixation and 3 received a complex total hip arthroplasty.

The median EBL in patients treated exclusively with IlluminOss was 200 cc (R=150-700) while in patients receiving additional procedures the median EBL was 625 cc (R=150-900). Most patients with combined procedures required perioperative blood transfusions. Only one patient required ICU care postoperatively (vasopressor requirement secondary to cardiac disease).

Patients treated exclusively with IlluminOss remained in the hospital 2 days in average (R=1-4 days). Patients with combined procedures stayed 6 days in average (R=4-10). Half of the patients were discharged home but all patients had no restrictions in weight bearing upon discharge. Complications included superficial wound dehiscence and a PE. There were no mortalities.

Conclusion: IlluminOss is a versatile technique in providing surgical stabilization in very high-morbidity patients with pelvic metastatic bone disease.It can be used as a stand alone implant but also allows the use and combination with other implants, including screws and plates , minimizing surgical time and blood loss.The minimally invasive system permits the delivery and infusion of the polymer into the balloon, resulting in the filling of the cavity without extravasation, facilitating the treatment of non-contained defects. Other properties such as radiolucency, make this technology desirable in the oncologic patient.