[Surgery and percutaneous injection of acrylic cement in bone metastases]

The first step for treatment of bone metastases is to confirm the diagnosis, particularly if there is only one localisation, so as to exclude a primary bone tumour. Surgery and percutaneous injection of acrylic cement are both efficient to relieve pain. Their indications and timing have to be discussed in pluridisciplinary staff. Long bones metastases have to be nailed before pathologic fracture. If there is suspicion of hypervascularisation, the lesion has to be embolized before any procedure. Treatment of spinal metastases with neurological impairment is an emergency. Paraplegia may be a consequence within a few hours. They have to be treated in an orthopedic or neurosurgery department with the experience of posterior and anterior approach of the spine. Surveillance may be useful to diagnose these metastases before neurological impairment. Depending from the type of cancer, the chemo- and radiotherapy sensibility, the number of metastases, the condition of the posterior wall of the vertebra and the general condition of the patient, different surgical treatments may be possible going from complete resection of the lesion to percutaneous injection of acrylic cement. Conventional radiotherapy is associated to surgery. Satisfactory results of such treatments justify greater involvement of orthopaedic surgery team in multidisciplinary staff.