Abstract
PurposeThe objective of this prospective, randomised study was to examine the feasibility and clinical outcome of balloon sacroplasty and radiofrequency sacroplasty.MethodsIn 40 patients with a total of 57 sacral fractures, CT-guided cement augmentation was performed by means of BSP or RFS. For BSP, the balloon catheter was inflated and deflated in the fracture zone, and the hollow space, thus, created was then filled with PMMA cement. For RFS, the spongious space in the fracture zone was initially extended using a flexible osteotome, and the highly viscous PMMA cement, activated by radiofrequency, was then inserted into the prepared fracture zone. Pain intensity was determined on a VAS before the intervention, on the second day, and 6, 12 and 18 months after the intervention. The results were tested for significance by means of paired Wilcoxon rank-sum tests and Mann–Whitney U tests.ResultsBSP and RFS were technically fully feasible in all patients. An average of 6.3 ml cement per fracture was inserted in the BSP group and an average of 6.1 ml per fracture in the RFS group. Leakage could be ruled out for both procedures. The mean pain score on the VAS before the intervention was 8.6 ± 0.55 in the BSP group and 8.8 ± 0.58 in the RFS group. On the second postoperative day, a significant pain reduction was seen (p < 0.001), with an average value of 2.5 (BSP ± 0.28, RFS ± 0.38) for both groups. After 6 (12; 18) months, these values were stable for the BSP group at 2.3 ± 0.27 (2.3 ± 0.24; 2.0 ± 0.34) and for the RFS group at 2.4 ± 0.34 (2.2 ± 0.26; 2.0 ± 0.31). With regard to pain, exceedance probability values of p = 0.86 (6 months), p = 0.94 (12 months) and p = 1 (18 months) were seen, so that neither treatment method leads to differences in results.ConclusionsBSP and RFS are interventional, minimally invasive procedures that enable reliable cement augmentation and achieve equally good clinical outcomes in the medium term.
Highlights
Since insufficiency fractures of the sacrum were first described by Lourie in 1982 [1], knowledge about the clinical signs and the correct use of imaging diagnostics has improved, which means that these fractures are being detected increasingly frequently [2]
An average of 6.3 ml cement per fracture was inserted in the balloon sacroplasty (BSP) group and an average of 6.1 ml per fracture in the radiofrequency sacroplasty (RFS) group
The technical feasibility of cement augmentation in the fracture zone of a sacral insufficiency fracture could initially be shown for the vertebroplasty method [17], followed by balloon kyphoplasty [18] and radiofrequency augmentation [19]
Summary
Since insufficiency fractures of the sacrum were first described by Lourie in 1982 [1], knowledge about the clinical signs and the correct use of imaging diagnostics has improved, which means that these fractures are being detected increasingly frequently [2]. As a minimally invasive form of treatment, cement can be inserted via hollow needles, analogously to vertebroplasty [6,7,8,9,10]. Eur Spine J (2017) 26:3235–3240 substantiate this with an good clinical improvement when comparing vertebral and sacral cement augmentation. With balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS), interventional, minimally invasive treatment options have become established that, as a result of the methods used, minimise leakages and the complications with which they are associated [13, 14]
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