Scapuloplasty Alleviates Scapular Pain Resulting from Lung Cancer Metastasis

Osteoplasty, a highly effective minimally invasive procedure that alleviates the painful effects of metastatic bone disease by injecting bone cement to support weakened bones, provides immediate and substantial pain relief. However, it is rarely performed in non-weight bearing flat bones such as the scapula. Fractures of the body of the scapula are rarely treated surgically, except for cases of marked displacement of fragments that limit the function of the scapula. According to the reported incidences of operative treatment of different scapula fracture types, 99% of all isolated scapula body fractures are treated nonoperatively A 54-year-old man had been experiencing metastatic bone pain in the lateral border, medial border, and medial infraspinatus fossa of the left scapula for the past 2 months; this pain originated from adenocarcinoma of the right lung. He could not sleep on his back even after completion of radiation therapy. We decided to perform scapuloplasty. The patient was placed in the prone position on a radiolucent table with an inflatable adjustable axillary pillow. Three 13-gauge, 10-cm long bone biopsy needles were simultaneously inserted from the 3 different entry points to fill the osteolytic lesion with the bone cement with fluoroscopic guidance under local anesthesia and intravenous analgesia. After confirming needle placement and ensuring that no contrast medium was extravasated, a total of 8 mL of the cement was injected. Immediately after the operation, the patient could lie on his back without pain. Scapuloplasty is a new variant of osteoplasty used to alleviate the painful effects of metastatic bone disease. It may be an option of shoulder motion-preserving minimally invasive procedure for alleviating intractable pain induced by lying on the back. Key words: Fluoroscopy; lung neoplasms; neoplasm metastasis; polymethyl methacrylate; pain; palliative care; scapula; surgical procedures, minimally invasive; vertebroplasty.