Osteolyses

Percutaneous injection of methylmethacrylate (cementoplasty see Chap. 10) or ethanol (alcoholization) may provide marked pain relief or bone strengthening in patients with malignant acetabular osteolyses who are unable to tolerate surgery. Injection of methylmethacrylate is usually indicated when osteolysis involves the weight-bearing bone (i.e., vertebral body, acetabular roof). In non-weight-bearing bones, ethanol injection is preferred. 

There exist major differences between the thoracic (Tl-10) and thoracolumbar vertebral bodies (T11-L5), since the rib cage serves as a stabilizer of the thoracic vertebral column. Four factors have to be determined (1) percentage of osteolyses in the vertebral body, (2) presence of involvement of the pedicles, (3) posterior elements, and (4) costovertebral joint involvement at the thoracic spine (Taneichi et al. 1997). 

Percutaneous injection of PMMA for malignant osteolyses, including destruction of long bones (Fig. 2.10.9), acetabular osteolyses (Fig. 2.10.10), and... 

Gotten A, Deprez X, Migaud H et al (1995) Malignant acetabular osteolyses percutaneous injection of acrylic bone cement. Radiology 197 307-310 Gotten A, Boutry N, Cortet B et al (1998) Percutaneous vertebroplasty state of the art. Radiographics 18 311-320 discussion 320-313... 

Gotten A, Demondion X, Boutry N et al (1999) Therapeutic percutaneous injections in the treatment of malignant acetabular osteolyses. Radiographics 19 647-653 Cunin G, Boissonnet H, Petite H et al (2000) Experimental vertebroplasty using osteoconductive granular material. Spine 25 1070-1076... 

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