Patient's Selection and Evaluation for Bone Stabilization

Bone stabilization procedures performed by Interventional Radiologists have significantly increased in the past ten years with a wide variety of techniques available ranging from cementoplasty to complex combined treatment associating thermoablation, cementoplasty and fixation. Many available manuscripts and reviews focus on the technical aspects, feasibility and outcomes of these procedures. However, not every procedure is suitable for every patient, and therefore selecting a patient for a specific procedure represents the first necessary step to a successful procedure. This review will describe every step of the selection process which the Interventional Radiologists is confronted with prior to performing a consolidation procedure in the setting of bone cancer. Defining the clinical setting is mandatory and includes assessing the patient's clinical status, cancer stage, level of pain and disability will help define the objective of the procedure: curative, palliative intent. A thorough imaging assessment is also mandatory, as it will define the type of consolidation (cementoplasty or fixation) which will be performed depending on the anatomical location and size of the lesion, the type of stresses at stake (compression or shear) and it will help plan the needle pathway and assess for possible complications. The process of selecting a patient for a specific procedure should be performed by the Interventional Radiologist but should be validated in a multidisciplinary approach. Moreover, the objective of a procedure, including the expected outcome and possible adverse events and complications should clearly be explained to the patient.