Nicolas Stacoffe

Purpose To systematically review the available evidence on the feasibility, safety, and clinical effectiveness of percutaneous sclerotherapy using radiopaque gelified ethanol (RGE, Discogel®) for bone lesions. Methods A systematic search of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL was performed. Primary studies reporting clinical, technical, and safety outcomes following RGE sclerotherapy for bone lesions were included. Data on patient characteristics, lesion type, procedural details, and outcomes were extracted and synthesized descriptively. Results Six retrospective studies involving 55 patients (mean age 22.2 ± 20.4 years; range 3–65; 26 females) with 56 lesions and 119 procedures were included (mean 2.16 procedures per patient). Aneurysmal bone cysts (80%) and aggressive vertebral hemangiomas (18%) were the main indications. Technical success was reported in 100% of procedures. Pain outcomes were available for 28 patients, with complete resolution in 64.3% (18/28), partial reduction in 32.1% (9/28), and persistence in 3.6% (1/28). Radiological follow-up (50 lesions) demonstrated complete response in 96% and partial response in 4%. No major adverse events were reported according to CIRSE (≥ 4) or CTCAE (≥ 4) criteria. One SIR grade 3 vertebral fracture occurred without confirmed causal association to RGE. Subsequent surgery was required in 3.6% of lesions. Conclusion Although limited to small retrospective series, current evidence suggests that RGE sclerotherapy is a safe and effective minimally invasive option for selected benign bone lesions. Prospective comparative studies with longer follow-up are warranted.

Objectives: Management of unstable pelvic fractures during pregnancy presents a major therapeutic challenge, requiring careful multidisciplinary evaluation to balance maternal benefits and fetal radiation risks. Methods: We report the case of a 32-year-old patient who presented with a pelvic fracture due to a road traffic accident at three months of pregnancy. A left sacroiliac osteosynthesis was performed to treat a left sacroiliac diastasis with pelvic osteosynthesis using a trans-iliosacral approach under cone-beam CT (CBCT) guidance using a very-low-dose protocol. Radiation parameters and fetal dose estimates were calculated in advance in collaboration with a medical physicist. Tight beam collimation, a reduced field of view, and minimization of fluoroscopic checks were applied to keep fetal exposure as low as reasonably achievable. This article aims to demonstrate the feasibility of managing a complex pelvic fracture using interventional radiology and to review the literature on management options and gestational age-dependent fetal risks. Results: The estimated cumulative fetal dose from initial imaging, open surgery, and CBCT-guided osteosynthesis remained below 70 mGy using a pregnant phantom (Duke Organ Dose–Dosewatch–General Electric system), which is below thresholds associated with deterministic effects. The procedure achieved optimal screw positioning with less than 40 s of fluoroscopy. Maternal postoperative recovery was favorable, and follow-up revealed normal fetal development. Conclusions: This case demonstrates that CBCT-guided percutaneous iliosacral screw fixation can be safely performed during pregnancy with meticulous planning, dose-reduction strategies, and multidisciplinary collaboration, maintaining fetal radiation exposure below accepted safety thresholds.

Pulmonary artery pseudoaneurysms pose a therapeutic challenge due to their lack of a defined wall, making the choice of endovascular therapy crucial. The added complexity arises from their proximal location, often necessitating endovascular stenting for effective treatment. Our case highlights a successful therapeutic intervention involving stenting and glue embolization to address a sizable proximal pseudoaneurysm in the right pulmonary artery. This approach demonstrates the efficacy of combining these techniques in managing such challenging cases. The utilization of endovascular stenting, coupled with glue embolization, could be a therapeutic option in the context of giant pseudoaneurysms located proximally within the pulmonary artery.

Modic changes, particularly type 1, represent a significant clinical and radiologic challenge in chronic low back pain. This review evaluates the infectious hypothesis, suggesting that the colonization of the intervertebral disk by low-virulence pathogens (primarily Cutibacterium acnes) may contribute to the pathogenesis of these lesions. The evolution of this concept is analyzed through the results of pivotal clinical trials, highlighting the landmark perspectives provided by the Modic Antibiotic Spine Therapy study while considering the methodological nuances and divergent findings introduced by the Antibiotics in Modic Changes study. The article also examines the evidence from disk biopsy studies, addressing the technical difficulties in distinguishing true microbial colonization from potential sample contamination. Finally, we propose an integrative model where mechanical and infectious factors interact, suggesting that bone marrow inflammation may reflect a localized immune response to intradiskal bacterial presence. This balanced approach calls for the standardization of future research protocols to clarify the role of targeted therapeutic interventions.

In interventional radiology, percutaneous osteosynthesis has experienced major growth, pushing boundaries that were unimaginable 20 years ago. Driven by advanced imaging (computed tomography, cone-beam computed tomography, electromagnetic navigation, computed tomography-fluoroscopy fusion, and emerging robotics), by a refined understanding of bone biomechanics, and by improved knowledge of implant behavior (fully or partially threaded screws, washers, cement augmentation), its indications now extend from trauma to osteoporosis/insufficiency fractures and oncology. This article provides a practical framework for safely going “further”: rational selection of devices according to cortical or cancellous bone, planning of long or oblique trajectories (iliosacral, trans-sacro-bi-iliac, acetabular roof, odontoid, sternum), use of adjunct techniques (hydrodissection, thermal ablation, embolization), and, when necessary, external reduction maneuvers under image guidance. We highlight decision-making principles, indications, anatomical limitations, and pitfalls to avoid (sacral foramina, shear forces, narrow corridors), as well as adapted pain management and anesthesia strategies. By mastering indications, guidance systems, and a detailed understanding of underlying pathologies, interventional radiology offers minimally invasive, stable, and durable solutions. This approach accelerates patient remobilization and transforms situations once deemed inoperable into safe, personalized, and reproducible trajectories. These advances firmly establish interventional radiology as a central multidisciplinary actor in musculoskeletal care.