What is Surgical Stabilization for Bone Metastasis?
Surgical stabilization for bone metastasis is a procedure to strengthen and support bones weakened by metastatic cancer. When cancer spreads (metastasizes) to bones, it can make them fragile, leading to fractures and pain. Surgical stabilization aims to relieve pain, restore mobility, and improve the quality of life by reinforcing or replacing parts of the affected bone.
What are the Key Approaches Involved in Surgical Stabilization for Bone Metastasis?
Your surgeon may employ any of the following techniques during surgical stabilization for bone metastasis:
- Internal Fixation: Metal rods, screws, plates, or nails are used to stabilize the weakened bone, especially if there's a risk of fracture. This is common in weight-bearing bones, such as the femur.
- Joint Replacement: If the metastasis affects a joint severely, like the hip or shoulder, joint replacement might be recommended. A prosthetic joint is used to replace the damaged one, improving function and reducing pain.
- Bone Cement (PMMA): This cement-like material is injected into the bone to strengthen it and relieve pain. This is often used for spinal metastases (vertebroplasty or kyphoplasty) and other bones where simple reinforcement can help.
- Tumor Resection: In some cases, the cancerous section of the bone is removed, and the remaining bone is stabilized with rods or implants.
- Cryoablation or Radiofrequency Ablation: In addition to stabilization, cryoablation (freezing) or radiofrequency ablation (heating) may be used to reduce tumor size and relieve pain before stabilization.
Indications for Surgical Stabilization for Bone Metastasis
Indications for surgical stabilization in bone metastasis include:
- Severe Pain: Persistent pain unmanageable with medication or radiotherapy.
- Impending Fracture: Significant bone weakening in load-bearing areas, indicating a high risk of fracture.
- Pathologic Fracture: In cases where a bone has already fractured due to metastasis, surgery can help restore function and stabilize the area.
- Neurological Symptoms: For spinal metastases, surgery may be needed if there is nerve compression causing symptoms like weakness or loss of bowel/bladder control.
- Functional Decline: Loss of mobility or independence due to the instability caused by bone metastasis may warrant surgery to maintain quality of life.
- Poor Response to Other Treatments: If non-surgical options such as radiotherapy, chemotherapy, or bisphosphonates are not effective, surgery can provide symptom relief and structural support.
Preparation for Surgical Stabilization for Bone Metastasis
Preoperative preparation for surgical stabilization for bone metastasis may include the following:
- Imaging studies such as MRI, CT scans, and bone scans to help assess bone integrity and detect any metastasis locations. The imaging studies help surgeons to determine which stabilization technique (internal fixation, cementoplasty, or other) suits the patient’s anatomy and extent of bone loss, as well as provide critical guidance for surgical planning
- Laboratory analysis such as blood work to assess the patient’s overall health and any effects of cancer or previous treatments
- Informing your doctor of any allergies to medications, anesthesia, or latex
- Providing your physician with a list of any medications or supplements you are taking
- You may need to adjust or temporarily stop taking certain medications - especially those that can affect blood clotting
- Abstaining from food or drink for at least 8 hours prior to surgery
- Signing an informed consent form after the pros and cons of the surgery have been explained
Procedure for Surgical Stabilization for Bone Metastasis
Surgical stabilization procedure for bone metastasis is typically performed under general anesthesia and usually involves the following steps:
- The surgeon makes an incision near the affected bone or joint to access the area safely.
- If part of the bone is highly compromised by the tumor, the affected segment may be removed. This step is often combined with reconstructive techniques, such as:
- Internal Fixation: Metal plates, screws, rods, or nails are secured to the bone to reinforce it. In cases with a high risk of fracture (for example, in long bones like the femur), this approach is commonly used.
- Joint Replacement: If the tumor has damaged the bone near a joint, a prosthetic implant may replace the joint (for example, hip or shoulder replacement).
- Bone Cement (PMMA): Bone cement can be injected into the weakened area to reinforce it. This is common for vertebral stabilization (vertebroplasty/kyphoplasty) or in bones where adding a solid support structure is beneficial.
- If needed, additional ablative techniques such as cryoablation or radiofrequency ablation may be performed to reduce tumor size and address pain, especially in spinal metastases.
- After ensuring the hardware is stable, the incision is closed with sutures, and a sterile dressing is applied to prevent infection.
Postoperative Care and Recovery
The patient is taken to the recovery room, where they are monitored as the anesthesia wears off. Pain control with medication, such as analgesics or local anesthetics, is provided. Early mobilization and physical therapy are encouraged to improve strength, function, and overall recovery. The patient may need rehabilitation to adapt to any functional changes, with the goal of maximizing mobility and strength. Periodic imaging is used to check the implant’s position and the bone’s healing status. It can take several months for full recovery, depending on the individual and the type of technique employed for surgical stabilization.
Risks and Complications
In general, risks and complications associated with surgical stabilization for bone metastasis may include:
- Infection
- Bleeding
- Implant failure or loosening
- Delayed bone healing or non-union
- Blood clots (deep vein thrombosis or pulmonary embolism)
- Nerve or vascular injury
- Anesthesia-related risks
