Abstract
BackgroundSacral insufficiency fractures (SIFs) are a common cause of lower back pain in the elderly. However, because clinical symptoms are frequently vague and nonspecific and can mimic lumbar spine pathologies, initial imaging in SIF patients is frequently targeted at the lumbar spine rather than the sacrum, resulting in delayed diagnosis. The purpose of this study is to show the proportions of modalities used in diagnosing SIF in practice and to compare the clinical and imaging features of SIF diagnosed by lumbar spine MRI (L-spine MRI) with those diagnosed by non-lumbar imaging modalities (bone scan, pelvic bone CT, pelvis MRI).MethodsForty-two patients with SIF were enrolled in this study. SIFs diagnosed by L-spine were assigned to group 1 and SIFs diagnosed by non-lumbar imaging modalities (bone scan, pelvic bone CT, pelvis MRI) were assigned to group 2. The clinical and imaging features of SIFs were assessed and compared between two groups.ResultsSIF were more commonly diagnosed by L-spine MRI (group 1: n = 27, 64.3%) than non-lumbar imaging modalities (group 2: n = 15, 35.7%), which was comprised of pelvic bone CT (n = 6, 14.3%), bone scan (n = 5, 11.9%), and pelvis MRI (n = 4, 9.5%). Lower back pain, radiating pain and comorbid other causes of pain were more frequently identified in group 1. Fracture involving bilateral sacral ala with horizontal component was the most common shape and S2 being the most commonly involved horizontal component, without significant difference between two groups.ConclusionSIFs are more commonly diagnosed by L-spine MRI than non-lumbar imaging modalities, because of symptoms that mimic lumbar spine pathology and variable comorbid causes of pain. To know that L-spine MRI commonly reveal SIF and to be familiar with SIF features on L-spine MRI would help increase sensitivity in detecting this commonly underrecognized entity and achieve earlier and more appropriate management.
Highlights
Sacral insufficiency fractures (SIFs) are a common cause of lower back pain in the elderly
The purpose of this study is to show the proportions of modalities used in diagnosing SIF in practice and to compare the clinical and imaging features of SIF diagnosed by L-spine Magnetic resonance imaging (MRI) with those diagnosed by non-lumbar imaging modalities
SIFs initially detected by non-lumbar imaging modalities were assigned to group 2 (n = 15)
Summary
The purpose of this study is to show the proportions of modalities used in diagnosing SIF in practice and to compare the clinical and imaging features of SIF diagnosed by lumbar spine MRI (L-spine MRI) with those diagnosed by non-lumbar imaging modalities (bone scan, pelvic bone CT, pelvis MRI). Sacral insufficiency fractures (SIFs) are a common cause of lower back pain in the elderly, with a mean age between 70 and 75 years in most studies [1,2,3] They were first described as a clinical entity in 1982 by Lourie, and the awareness and reports of this entity have increased with the increasing number of elderly patients [4, 5]. The purpose of this study is to show the proportions of modalities used in diagnosing SIF in practice and to compare the clinical and imaging features of SIF diagnosed by L-spine MRI with those diagnosed by non-lumbar imaging modalities (bone scan, pelvic bone CT, pelvis MRI) Many authors suggest radiologists and clinicians to be aware of this entity in interpreting L-spine MRI in old age patients [1, 9], there has been no study that revealed the proportion of L-spine MRI among the
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