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Background <p>Upper sacral (S1–S2) metastases frequently cause severe pain, pathological fractures, and neurological compromise. Conventional treatments, including open surgery, standalone ablation or sacroplasty, and radiotherapy, are often limited by high morbidity, insufficient mechanical stability, or delayed pain relief. This study evaluated the feasibility, clinical outcomes, and biomechanical characteristics of a robot‑assisted multimodal minimally invasive strategy for upper sacral malignant tumors.</p> Methods <p>This single‑center retrospective study included 10 patients with pathologically confirmed upper sacral malignant tumors treated between July 2020 and July 2025. The procedure consisted of robot‑guided trajectory planning, percutaneous microwave ablation (MWA), sacroiliac cannulated screw fixation, and polymethylmethacrylate (PMMA) cement augmentation. Clinical outcomes included visual analog scale (VAS) pain scores, Oswestry Disability Index (ODI), perioperative parameters, complications, and time to initiation of adjuvant therapy. Finite element analysis (FEA) was performed to compare sacral stress distribution and deformation under ambulatory loading conditions across different pelvi‑sacral lesion types and reinforcement strategies.</p> Results <p>The cohort comprised 5 males and 5 females with a median age of 60 years (range, 51–72) and a median Katagiri score of 5 (range, 4–6). Median operative time was 50&#xa0;min, median intraoperative blood loss was 50 mL, and the median PMMA volume was 3 mL. Median VAS scores decreased significantly from 8 preoperatively to 3 at postoperative day 3, 2 at 1 month, and 2 at 6 months (all <i>p</i> &lt; 0.001). Median ODI scores improved from 36 preoperatively to 24 at 1 month and 22 at 6 months postoperatively (both <i>p</i> &lt; 0.001). Adjuvant therapy was initiated at a median of 6 days after surgery. No acute or long-term procedure‑related complications were observed. FEA demonstrated that combined cement–screw fixation reduced sacral peak stress and deformation compared with lesion models.</p> Conclusions <p>Robot-assisted percutaneous MWA with cement augmentation and cannulated screws appears feasible as a minimally invasive option for selected upper sacral metastases, delivering rapid pain relief and early recovery that may enable timely adjuvant radiochemotherapy. These findings provide preliminary clinical and biomechanical evidence supporting this multimodal strategy, which warrants further validation in larger prospective studies.</p>

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Finite element validation and short-term clinical outcomes of robot-assisted percutaneous microwave ablation plus cement augmentation and sacroiliac screw fixation for upper sacral (S1–S2) metastases

  • 期刊论文

  • 发表日期：

    2026年2月26日

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  • Jianping Hu,
  • Jiazhuang Zhu,
  • Xingkai Wang,
  • Kunpeng Zhu,
  • Xiaolong Ma,
  • Chunlin Zhang,
  • Tiantian Gao

摘要

Background

Upper sacral (S1–S2) metastases frequently cause severe pain, pathological fractures, and neurological compromise. Conventional treatments, including open surgery, standalone ablation or sacroplasty, and radiotherapy, are often limited by high morbidity, insufficient mechanical stability, or delayed pain relief. This study evaluated the feasibility, clinical outcomes, and biomechanical characteristics of a robot‑assisted multimodal minimally invasive strategy for upper sacral malignant tumors.

Methods

This single‑center retrospective study included 10 patients with pathologically confirmed upper sacral malignant tumors treated between July 2020 and July 2025. The procedure consisted of robot‑guided trajectory planning, percutaneous microwave ablation (MWA), sacroiliac cannulated screw fixation, and polymethylmethacrylate (PMMA) cement augmentation. Clinical outcomes included visual analog scale (VAS) pain scores, Oswestry Disability Index (ODI), perioperative parameters, complications, and time to initiation of adjuvant therapy. Finite element analysis (FEA) was performed to compare sacral stress distribution and deformation under ambulatory loading conditions across different pelvi‑sacral lesion types and reinforcement strategies.

Results

The cohort comprised 5 males and 5 females with a median age of 60 years (range, 51–72) and a median Katagiri score of 5 (range, 4–6). Median operative time was 50 min, median intraoperative blood loss was 50 mL, and the median PMMA volume was 3 mL. Median VAS scores decreased significantly from 8 preoperatively to 3 at postoperative day 3, 2 at 1 month, and 2 at 6 months (all p < 0.001). Median ODI scores improved from 36 preoperatively to 24 at 1 month and 22 at 6 months postoperatively (both p < 0.001). Adjuvant therapy was initiated at a median of 6 days after surgery. No acute or long-term procedure‑related complications were observed. FEA demonstrated that combined cement–screw fixation reduced sacral peak stress and deformation compared with lesion models.

Conclusions

Robot-assisted percutaneous MWA with cement augmentation and cannulated screws appears feasible as a minimally invasive option for selected upper sacral metastases, delivering rapid pain relief and early recovery that may enable timely adjuvant radiochemotherapy. These findings provide preliminary clinical and biomechanical evidence supporting this multimodal strategy, which warrants further validation in larger prospective studies.