CT-guided sacroplasty for the treatment of sacral insufficiency fractures

Abstract

To describe the clinical presentation, procedure and outcome in patients treated with computed tomography (CT)-guided sacroplasty as a treatment for sacral insufficiency fractures. Three patients (mean age 80 years, range 75-87 years) were treated with CT-guided sacroplasty. The mean pre-procedure visual analogue score (VAS) for pain was 8 (range 7-9) with a mean symptom duration of 8 months (range 2.5-18). The procedure was performed under CT guidance with needles being placed along the fracture lines from a posterior approach. Polymethylmethacrylate (PMMA) cement was introduced in 0.2 ml aliquots after cement temperature reduction. Cement injection was monitored by four-section block axial acquisition to assess potential cement migration. All three procedures were performed without significant complication. One patient developed a tiny asymptomatic cement leak into the S1 foramen. The mean volume of cement injected into a unilateral sacral fracture was 4 ml. All patients tolerated the procedure well under intravenous sedation. The mean VAS score post-procedure was 2. Continued symptomatic relief was seen at 6 weeks and 3 months. CT-guided sacroplasty represents an alternative treatment for sacral insufficiency fractures that are resistant to conservative treatment. The symptomatic relief the procedure produces seems to be excellent both in this small series and in described cases in the literature.