A Surgical Technique Guide for Percutaneous Screw Fixation for Metastatic Pelvic Lesions

Background: The pelvis is one of the most common areas for metastatic bone disease. We recently described the use of a minimally invasive percutaneous screw fixation of metastatic non-periacetabular pelvic lesions, with excellent results.

Description: The procedure can be completed in a standard operating theater without the need for special instruments. In our video we describe the appropriate intraoperative patient positioning, surgical equipment, surgical approach, and obtainment of the necessary fluoroscopic views for placement of various pelvic percutaneous screws.

Alternatives: Alternative treatments include surgical procedures such as curettage, cement packing, and modified Harrington total hip arthroplasty through extensive open approaches. Additionally, as an alternative to standard fluoroscopy, intraoperative navigation and an O-arm could be utilized for the placement of screws. In our experience, intraoperative navigation has been helpful for confirmation of final screw placement and length. Overreliance on intraoperative navigation in the setting of poor bone quality and an abandonment of tactile feedback and the various tips described in this video article can lead to inadvertent extraosseous screw placement and injury. Furthermore, as navigation involves only a virtually computed image, we have found it challenging to utilize in complex, curved bones, such as the superior pubic ramus.

Rationale: Percutaneous screw fixation is safe and effective for the treatment of metastatic non-periacetabular pelvic lesions. Given the simplicity of the technique and instrumentation, and the tolerance of concomitant treatments, this approach is worthy of broader consideration.

Expected outcomes: In our recent study, 22 consecutive patients with painful non-periacetabular pelvic metastatic cancer underwent percutaneous screw fixation. There were no surgical complications. Postoperatively, there was significant improvement in visual analog scale pain scores and functional Eastern Cooperative Oncology Group scores, as compared with baseline³.

Important tips: Despite the simplicity of the intraoperative set-up and instrumentation, the procedure is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging.

Acronyms and abbreviations: CT = computed tomographyASIS = anterior superior iliac spineGT = greater trochanterAP = anteroposteriorAIIS = anterior inferior iliac spineSI = sacroiliacTSTI = transsacral-transiliacVAS = visual analog scaleECOG = Eastern Cooperative Oncology GroupDVT = deep vein thrombosis.