Palliative percutaneous stabilization of lower extremity for bone metastasis using flexible nails and bone cement

Percutaneous stabilization (PS; percutaneous flexible nailing and intramedullary bone cement injection) was performed at lower extremity long bones in patients with multiple bone metastases with short life expectancy to get mechanical stability and local tumor control. We evaluated the usefulness of PS by clinical status, F-18-FDG PET-CT and bone scintigraphy (BS).

Patients comprised 15 patients (total 20 sites) who had undergone PS for the metastatic bone tumors of lower extremity long bones (femur and tibia). After percutaneous flexible nailing, bone cement was injected (mean amount=15.5±6.4 ml). Patients' clinical status was evaluated by visual analog scale (VAS). Qualitative assessment of PET-CT and BS was categorized by improved, stable and aggravated states of PS lesion. Quantitative assessment of PET-CT was performed by maximum and mean standardized uptake value (SUVmax and SUVmean).

PS was performed in all of the patients without complication, and showed significant pain improvement of VAS (7.2±0.2 vs. 2.8±0.3, P<0.001). PS lesion showed improved state in 65% (13/20) and stable state in 35% (7/20). However, naive bony metastatic lesion showed mostly aggravated state in 90% (19/20) in the same patients, which was significantly different compared with PS lesion (P<0.001). In PS lesion, SUVmax (10.1±6.9 vs. 7.1±5.2, P=0.008) and SUVmean (6.2±4.8 vs. 4.6±3.7, P=0.008) showed significantly decreased uptake after PS.

By PS in lower extremity long bones, patients can reduce regional pain, and has the possibility of local tumor control. PS can be performed for lower extremity bone metastasis in poor general condition to perform conventional intramedullary nailing.