Percutaneous Sacroplasty Research Articles

Perfecting the pour: A novel co-axial technique with sequential injections for optimising cement delivery during sacroplasty.

Percutaneous sacroplasty is an effective treatment for painful sacral fractures and tumours, however there is no accepted optimal technique for performing this procedure. This study investigated a novel approach to sacroplasty combining co-axial sacral access, sequential cement injections and hypothermic cement manipulation to improve cement delivery. This retrospective study analysed 11 patients who underwent co-axial sacroplasty between April 2023 and March 2024 for treatment of painful insufficiency fractures (n = 5) or malignant sacral tumours (n = 6). All cases were performed using biplane fluoroscopy with conebeam CT navigation for planning and monitoring percutaneous access. Procedural details, technical outcomes, and clinical outcomes including Numerical Rating Scale (NRS) pain and analgesic utilisation on a six-point scale were analysed pre-procedure and at follow-up. Technical success of was achieved in all cases using this technique. The mean injected cement volume was 20.5 ± 6.4 ml. Median pre-procedural NRS pain scores of 8 (IQR 7.25-8) significantly decreased to 0 (IQR, 0-0.25) at follow-up (p <.01). The median preprocedural analgesic utilisation score reduced from 3 (IQR, 2-3) to 0 (IQR, 0-2.5) at follow-up (p <.01). Cement leakage occurred during two cases without associated adverse clinical sequelae. There were no major adverse events. Co-axial sequential injection sacroplasty is a safe and effective technique which allows facilitates controlled delivery of cement. Improved control of cement delivery, including around high-risk structures for cement leakage, offers a potential safety advantage over conventional sacroplasty techniques. Further research comparing technical and clinical outcomes to conventional techniques is warranted.

Sacroplasty for Zone III Sacral Insufficiency Fracture: A Case Report Utilizing a Midline Approach and Articulating Osteotome

BACKGROUND: Sacral insufficiency fractures can be a debilitating cause of low back pain in the elderly population. While sacroplasty is recommended for the treatment of persistent pain from sacral insufficiency fractures, the anatomical location of Zone III fractures can put patients at a higher risk of neurological complications during repair. CASE REPORT: We present a case of a 71-year-old woman with a Denis Zone III sacral insufficiency fracture who underwent percutaneous sacroplasty. The procedure was performed by utilizing an articulating osteotome in the long-axis approach along the curvature of the sacrum. The use of an articulating osteotome allowed for small trajectory adjustments, thereby lowering the procedural risks of cement extravasation and erroneous cannulation. CONCLUSIONS: The patient reported significant pain relief and no immediate complications following the procedure. Fluoroscopically guided percutaneous sacroplasty using an articulating osteotome is a safe and effective method for treating sacral insufficiency fractures. KEY WORDS: Sacrum, bone fracture, sacroplasty, back pain, case report

Comparison of patterns and rates of cement leakage in percutaneous sacroplasty for sacral insufficiency fractures versus neoplasia.

Percutaneous sacroplasty is a minimally invasive procedure which utilises injection of bone cement into the sacrum for stabilisation of osteoporotic sacral insufficiency fractures (SIF) and neoplastic lesions to relieve pain and improve function. While effective, cement leakage is an important complication associated with the procedure. This study aims to compare the incidence and patterns of the cement leakages following sacroplasty for SIF versus neoplasia and discuss the various patterns of cement leakage and their implications. This retrospective study analysed 57 patients who underwent percutaneous sacroplasty at a tertiary orthopaedic hospital. Patients were divided into 2 groups of SIF (n=46) and neoplastic lesions (n=11) based on their indication for sacroplasty. Pre- and post-procedural CT fluoroscopy was used to assess for cement leakage. The incidence and patterns of cement leakage were both compared among the two groups. A Fisher's exact test was used for statistical analysis. Eleven (19%) patients had cement leakage on post-procedural imaging. The most common sites of cement leakage were into the presacral region (6), followed by sacroiliac joints (4), sacral foramina (3) and posterior sacral (1). There was a statistically significant higher incidence of leakage in the neoplastic group in comparison to SIF group (P-value <0.05). The incidence of cement leakage in the neoplastic group was 45% (n = 5/11) versus SIF 13% (n=6/46). There was a statistically significant higher incidence of cement leak in sacroplasties conducted for the treatment of neoplastic lesions compared to those with sacral insufficiency fracture.

Percutaneous Sacroplasty for Symptomatic Sacral Pedicle Screw Loosening.

This study aimed to evaluate the efficacy of fluoroscopy-guided percutaneous sacroplasty in patients with sacral pedicle screws loosening after instrumented spinal fusion. We retrospectively reviewed the medical records of 18 patients who underwent percutaneous sacroplasty to treat sacral pedicle screws loosening from January 2016 to December 2019. Imaging studies, visual analog scale (VAS), length of hospital stay, and complications were recorded. The clinical outcomes based on the Oswestry disability index (ODI) and the modified Brodsky's criteria (MBC) were also evaluated to determine the efficacy of percutaneous sacroplasty. All patients had undergone at least 1year of follow-up in our institute (range, 12-24months). The average VAS score was 5.6 (range, 4-7) before surgery and decreased to 1.7 (range, 1-3) at the final visit. All patients were discharged on the next day after surgery. No patients experienced complications, such as cement leakage, deep infection, or neurologic deterioration. All patients achieved good or excellent outcomes based on the MBC. The ODI scores improved from 51.8preoperatively to 25.6postoperatively. Percutaneous sacroplasty was an effective treatment approach for relieving the patient's symptoms caused by sacral pedicle screws loosening and could be a valuable treatment alternative to extensive revision surgery. IV.

Percutaneous Sacroplasty with or without Radiofrequency Ablation for Treatment of Painful Sacral Metastases.

Percutaneous sacroplasty is a variation of percutaneous vertebroplasty that has gained attention as a therapeutic option for patients with painful sacral insufficiency fractures due to osteoporosis or metastases. Additionally, percutaneous sacroplasty can also be used to treat painful sacral metastases without a pathologic fracture. The purpose of this retrospective study was to compare the efficacy and safety of fluoroscopy-guided percutaneous sacroplasty alone versus percutaneous sacroplasty plus radiofrequency ablation for the treatment of painful sacral metastases. For this retrospective study, 126 patients (with a total of 162 painful sacral metastases) were enrolled from October 2012 to February 2021 and assigned to receive either percutaneous sacroplasty plus radiofrequency ablation (n = 51, group A) or percutaneous sacroplasty alone (n = 75, group B). Four different approaches were used for percutaneous sacroplasty: transiliac, interpedicular, anterior-oblique, and posterior. The Visual Analog Scale, Oswestry Disability Index, and Karnofsky Performance Scale were used to evaluate outcomes. The Visual Analog Scale, Oswestry Disability Index, and Karnofsky Performance Scale scores showed significant improvement in both groups after treatment (P < .05). The overall pain relief rate was significantly better in group A than in group B (90% versus 76%, P = .032). There were no significant differences in the incidence of polymethylmethacrylate leakage between the 2 groups or among the 4 different approaches (P > .05). Both percutaneous sacroplasty alone and the combination of percutaneous sacroplasty and radiofrequency ablation are safe and effective for treatment of painful sacral metastases. The combination of percutaneous sacroplasty and radiofrequency ablation appears to be more effective than percutaneous sacroplasty alone.

The "Eiffel Tower" technique: novel long-axis sacroplasty under electromagnetic navigation assistance; feasibility and descriptive study.

To describe a novel long-axis multimodal navigation assisted technique - the so-called Eiffel Tower technique - aimed at integrating recent technological improvements for the routine treatment of sacral insufficiency fractures. The long-axis approach described in the present study aimed at consolidating the sacral bone according to biomechanical considerations. The purpose was (i) to cement vertically the sacral alae all along and within the lateral fracture lines, resembling the pillars of a tower, and (ii) to reinforce cranially with a horizontal S1 landing zone (or dense central bone) resembling the first level of the tower. An electromagnetic navigation system was used in combination with CT and fluoroscopic guidance to overtop extreme angulation challenges. All patients treated between January 2019 and October 2021 in a single tertiary center were retrospectively reviewed. A description of the technique is provided. Twelve female patients (median age: 80 years [range: 32 to 94]) were treated for sacral insufficiency fractures with the "Eiffel Tower" technique. The median treatment delay was 8 weeks (range: 3 to 20) and the initial median pain assessed by the visual analogue scale was 7 (range: 6 to 8). Pain was successfully relieved (visual analogue score < 3) for 9 patients (75%) and persisted for 2 patients (17%). One patient was lost during the follow-up. No complication was noted. The "Eiffel Tower" multimodal cementoplasty integrates recent technological developments, in particular electromagnetic navigation, with the purpose of reconstructing the biomechanical chain of the sacral bone. • Sacral insufficiency fractures are common and can be efficiently treated with percutaneous sacroplasty. • The long axis sacroplasty approach can be challenging given both the shape of the sacral bone and the angulation to reach the target lesion. • The "Eiffel Tower" technique is a novel approach using electromagnetic navigation to expand the concept of the long axis route, adding a horizontal S1 landing zone.

Fracture behavior of cancellous bone and cancellous bone-PMMA bone cement interface: An experimental study using an integrated methodology (wedge splitting test and Heaviside-based digital image correlation)

Minimally invasive methods, such as balloon kyphoplasty (BKP) and percutaneous sacroplasty (PS), which are now widely used for the surgical treatment of compression fractures, involve injection of a bolus of poly (methyl methacrylate) bone cement (hereafter, “bone cement”) into the fractured tissue. Many of the common complications following these surgeries, such as cement leakage and adjacent-level fractures (in the case of BKP), have been postulated to be related to the quality of the cancellous bone–bone cement interface, which, in turn, is a function of its fracture resistance. It is common to use bovine cancellous bone or polyurethane foam (PF) as a substitute for human cancellous bone in biomechanical studies of these surgical methods. The literature is lacking in studies of determination of fracture properties of human cancellous bone–bone cement interface, bovine cancellous bone–bone cement interface, and PF–bone cement interface. In the present work, an integrated methodology (combination of wedge splitting test and Heaviside-based digital image correlation) was used to make these determinations as well as those for the bone cement, bones and the PF alone. The fracture properties determined were maximum fracture load (Fmax), fracture toughness (Kc), and specific fracture energy (Gf). For example, Gf values for human cancellous bone and human cancellous bone–bone interface were 0.48±0.14 N/mm and 0.38±0.05 N/mm, respectively, whereas in the case of bovine cancellous bone and bovine cancellous bone–bone cement interface, they were 1.08±0.11 N/mm and 0.22±0.05 N/mm, respectively, and for PF (Grades 12.5 and 15.0) and PF–bone cement interface, they were 0.81±0.12 and 0.55±0.06 N/mm, respectively. The same trends were seen in the Fmax and Kc results. These results suggest that it may not be justified to use either bovine cancellous bone or either of the PF grades as a substitute for human cadaveric cancellous bone in biomechanical studies of BKP, PS, and similar surgical methods.

Combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance for osteoporotic sacral insufficiency fracture

BackgroundSacral insufficiency fracture (SIF) is rarer than osteoporotic vertebral compression fracture that occurs at other levels of the thoracolumbar spine. Percutaneous sacroplasty can effectively relieve pain and improve mobility. Several sacroplasty-based techniques have been reported to date.Sacroplasty is often performed with computed tomography-guided cannula placement, which is time intensive and results in greater radiation exposure than that resulting from fluoroscopy. Herein, we report our preliminary experience with a combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance for osteoporotic SIFs.MethodsWe retrospectively reviewed 44 consecutive patients with symptomatic osteoporotic SIFs who underwent alar sacroplasty between January 2013 and February 2020. The study group comprised 19 patients who underwent a combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance. The control group comprised the remaining 25 patients who underwent short-axis alar sacroplasty under fluoroscopic guidance. Visual analog scale (VAS) scores, operation times, injected cement volumes, and postoperative complications were recorded.ResultsThe VAS score for pain decreased in both groups; however, no significant difference was noted between the study and control groups in injected cement volume (3.55 ± 0.96 vs 2.94 ± 0.89 mL). The operation time was longer in the study group than in the control group (32 ± 7.1 vs 28.04 ± 4.99 min; P = 0.046). No major complications were noted.ConclusionA combination of long- and short-axis alar sacroplasty techniques can be effectively performed under fluoroscopic guidance for osteoporotic SIFs.

Percutaneous Sacroplasty : Effectiveness and Long-Term Outcome Predictors.

ObjectiveTo evaluate the effectiveness and long-term outcome predictors of percutaneous sacroplasty (PSP). MethodsThis single-center study assessed 40 patients with sacral insufficiency fractures using the short-axis technique under C-arm flat-panel detector computed tomography (CT). Two radiologists reviewed the patients’ magnetic resonance and CT images to obtain imaging findings before PSP and determine technical success, respectively. The short-term outcomes were visual analog scale score changes and opioid usage reductions. Long-term outcomes were determined using telephone interviews and the North American Spine Society (NASS) patient-satisfaction index at least one year after PSP. ResultsTechnical success was achieved without any significant complications in 39 patients (97.5%). Telephone interviews were possible with 12 patients and failed in 10 patients; death was confirmed in 18 patients. Fifteen patients (50%) re-visited the hospital and received conservative treatment, including spinal injections. Nine patients reported positive satisfaction (NASS patient-satisfaction index 1 or 2), while the negative satisfaction group (NASS patient-satisfaction index 3 or 4, n=3) showed a higher incidence of compression fractures at the thoracolumbar spine level (66.7% vs. 22.2%) and previous spinal injection history (66.7% vs. 33.3%). The poor response group also showed higher incidences of facet joint arthrosis (100% vs. 55.6%), central canal stenosis (100% vs. 22.2%), neural foraminal stenosis (33.3% vs. 22.2%), scoliosis (100% vs. 33.3%), and sagittal malalignment (100% vs. 44.4%). ConclusionPSP was effective for sacral insufficiency fractures and showed good long-term outcomes. Combined compression fractures in the thoracolumbar spine and degenerative lumbar pathologies could be possible poor outcome predictors.

Fluoroscopy-Guided Percutaneous Sacroplasty for Painful Metastases at the Sacral Ala.

ObjectivePercutaneous sacroplasty (PSP) is widely used in the clinic for osteoporotic sacral insufficiency fractures; however, few reports have described the safety and effectiveness of PSP for painful sacral metastases at the sacral ala under fluoroscopy alone. We aimed to evaluate the safety and efficacy of fluoroscopy-guided PSP for painful metastases at the sacral ala.Patients and MethodsThirty-five consecutive patients (median age, 60.74 ± 12.74 years), with a total of 41 metastatic lesions at the sacral ala, were treated with PSP. The patients were followed up for periods ranging from 1 month to 30 months (average, 8.23 ± 6.75 months). The visual analog scale (VAS), Oswestry Disability Index (ODI), and Karnofsky Performance Scale (KPS) were used to evaluate pain, mobility, and quality of life before the procedure and at 3 days and 1, 3, 6, 12, and 18 months after the procedure.ResultsTechnical success was achieved in all patients. The minimum follow-up duration was 1 month. The mean VAS scores declined significantly from 7.20 ± 0.93 before the procedure to 3.43 ± 1.38 by day 3 after the procedure, and was 3.13 ± 1.07 at 1 month, 3.17 ± 1.15 at 3 months, 2.91± 1.38 at 6 months, and 2.57 ± 1.51 at 12 months after the procedure (P < 0.001). After PSP, analgesic drug administration had been discontinued in 31 of 35 patients (88.57%). The ODI and KPS also changed after PSP, with significant differences between the baseline scores and those at each follow-up examination (P < 0.001). Extraosseous cement leakage occurred in 12 cases without any major clinical complications.ConclusionPSP is a safe and effective technique for the palliative treatment of painful metastases involving the sacral ala under fluoroscopic guidance alone. It can relieve pain, reduce disability, and improve function, and is associated with minimal complications.

Safety and efficacy of percutaneous sacroplasty for treatment of sacral insufficiency fractures: a systematic review.

Sacral insufficiency fractures are a common source of back pain in the elderly and are associated with significant morbidity due to poor recognition and delays in diagnosis. Previous treatment modalities have centered primarily on bed rest, oral analgesia, early mobilization and physical therapy. However, in recent years sacroplasty has emerged as a viable treatment option for sacral insufficiency fractures. Earlier recovery with sacroplasty, reduced incidence of deep venous thrombosis, and earlier return to activities of daily living are some of the features that made this treatment modality more appealing than traditional conservative management. We undertook a systematic review of the literature to examine the efficacy of sacroplasty for treatment of sacral insufficiency fractures in the elderly population. Thirty-one articles were included in this study for final analysis. Cement extravasation was the most commonly reported complication; however, it was not found to have clinical significance in the majority of studies that reported this outcome. Two studies reported S1 radicular pain after the procedure while only one study reported a patient with persistent pain requiring reoperation (1/8 incidence, 12.5%). The mean reduction in pain score from pre-procedure to latest follow-up post-procedure [reported as visual analog scale (VAS)] was 5.8+1.3 for those studies that reported this figure. Overall, sacroplasty is a safe and effective procedure associated with low complication rate and consistent pain relief in patients with sacral insufficiency fractures.

Precise percutaneous sacroplasty assisted by a Renaissance robot for sacral insufficiency fractures

Objective To evaluate the precise percutaneous sacroplasty (PSP) assisted by a Renaissance robot for sacral insufficiency fractures (SIF). Methods The clinical data of 12 SIF patients were retrospectively analyzed who had been treated from March 2016 to March 2018 at Department of Spinal Surgery, Honghui Hospital. They were 5 males and 7 females, aged from 55 to 76 years (average, 67.5 years). They all received PSP assisted by a Renaissance robot. Their operation time, hospital stay and intraoperative radiation were recorded. The clinical efficacy was evaluated by comparing their visual analogue scale (VAS) and Oswestry disability index (ODI) before surgery, 1 day, 3 and 12 months after surgery. Results All the 12 patients underwent surgery successfully with no complications like cement leakage. Their operation time ranged from 32 to 47 minutes (mean, 36.8 minutes), their hospital stay from 12 to 25 hours (mean 17.5 hours) and their intraoperative exposure to radiation from 0.87 to 1.53 mSv (mean, 1.27 mSv). All the patients were followed up for 12 to 18 months (mean, 15.8 months). Their VAS (1.7±0.7) and ODI (22.8±4.1) one day after surgery were significantly decreased than the preoperative values(7.6±0.9 and 43.7±4.6) (P 0.05). Conclusion The PSP assisted by a Renaissance robot is safe and leads to satisfactory clinical efficacy for SIF as bone cement can be accurately injected into the target area of the fracture. Key words: Sacrum; Osteoporosis; Fractures, bone; Vertebroplasty; Renaissance spinal robot

Percutaneous Sacroplasty for Sacral Insufficiency Fractures: Case Series and Review of Presentation, Diagnosis, and Treatment

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

Percutaneous Sacroplasty for Painful Sacral Metastases Involving Multiple Sacral Vertebral Bodies: Initial Experience with an Interpedicular Approach.

ObjectiveTo report our initial experience of percutaneous sacroplasty (PSP) with an interpedicular approach for treating painful sacral metastases involving multiple sacral vertebral bodies.Materials and MethodsThis study prospectively enrolled 10 consecutive patients (six men and four women; mean age, 56.3 ± 13.8 years) who underwent PSP for painful sacral metastases involving multiple sacral vertebral bodies from March 2017 to September 2018. Visual analogue scale (VAS) scores, Oswestry disability index (ODI) values, and the number of opioids prescribed to the patients were assessed before and after PSP. The procedure duration, length of hospitalization, and complications were also recorded.ResultsMean VAS and ODI declined significantly from 6.90 ± 1.20 and 74.40 ± 5.48 before the procedure to 2.70 ± 1.34 and 29.60 ± 14.57 after the procedure, respectively (p < 0.01). The median number of opioids prescribed per patient decreased from 2 (interquartile range [IQR] 1-3) pre-procedure to 1 (IQR 0–3) post-procedure (p < 0.01). Nine of the 10 patients showed no or decreased opioid usage, and only 1 patient showed unchanged usage. The mean procedure duration was 48.5 ± 3.0 minutes. The average length of hospitalization was 4.7 ± 1.7 days. Extraosseous cement leakage occurred in three cases without causing any clinical complications.ConclusionPSP with an interpedicular approach is a safe and effective treatment in patients with painful sacral metastases involving multiple sacral vertebral bodies and can relieve pain and improve mobility.

Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations

Background: The treatment of sacral fractures has evolved since its first description in 1982. Several techniques for sacral augmentation have been developed since 2001, and the rate of improvement is rapid with over 50% reduction in pain achieved prior to post-procedure discharge of the patient. Pain reduction occurs primarily within the first 3 months and is sustained at 12 months; however, the long-term outcomes have not previously been studied. Objectives: We aim to evaluate the long-term efficacy of sacroplasty versus non-surgical management (NSM) in treating sacral insufficiency fractures (SIFs), including the effect on pain relief, opioid and other analgesic use, patient satisfaction, and complication rates. Additionally, we aim to review the most current sacroplasty literature. Study Design: A 10-year prospective, observational cohort study of patients with SIFs treated with sacral augmentation. Setting: A single-center interventional pain management private practice. Methods: Two-hundred and forty-four patients with SIFs were treated with sacroplasty (210 patients) or NSM (34 patients) beginning in January 2004 and then followed for 10 years. The patients’ gender, age, pre-procedure pain duration, analgesic use, pain level, and satisfaction were recorded at baseline and at post-procedure follow-up intervals of 2, 4, 12, 24, 52 weeks, and 2 years. The experimental group was then contacted at 10 years. Post-procedure complications before discharge and at each follow-up were also evaluated. Results: Both NSM and sacroplasty resulted in statistically significant drops in visual analog scale (VAS) scores from pre-treatment to 2-year follow-up (P &lt; 0.001). When measured from followup to follow-up, the NSM group’s only significant decrease in the mean VAS score was between pre-treatment and 2 weeks (P = 0.002). The experimental group had significant decreases over the periods pre-op through post-op (P &lt; 0.001), post-op through 2 weeks (P &lt; 0.001), 12 weeks through 24 weeks (P = 0.014), and 24 weeks through one year (P = 0.002). The experimental cohort experienced statistically significant drops in the mean VAS scores between follow-ups for a longer period of time. Opioid and non-opioid analgesic use was markedly decreased preoperatively to postoperatively and was sustained at the 10-year follow-up. Limitations: Patients were placed into the control group, NSM, if they did not meet inclusion criteria for sacroplasty. However, the baseline characteristics of the sacroplasty versus NSM group were not statistically different. Additionally, the control group was only followed through 2 years and was not contacted at the 10-year follow-up. Conclusions: Our results and those reported in previous studies establish that sacroplasty allows for decreased use of medications and results in pain relief, greater patient mobility, and improved patient satisfaction. In addition to the published body of literature, our results show strong evidence in support of sacroplasty as a safe and efficacious treatment of SIFs. Key words: Sacroplasty, sacral fracture, fracture, osteoporosis, insufficiency, radiology

Percutaneous Sacroplasty for Non-neoplastic Osteoporotic Sacral Insufficiency Fractures

Background: Osteoporosis is an important problem in those of advanced age. Osteoporosis can induce sacral insufficiency fractures (SIFs). As average life expectancy increases, the number of patients with osteoporotic SIFs also increases. Osteoporotic SIFs cause severe low back pain and immobilization. Treatment of SIFs varies from analgesia to surgery. Objectives: To describe our experience and assess the safety and effectiveness of minimally invasive percutaneous sacroplasty in patients with osteoporotic SIFs. Study Design: Retrospective evaluation. Setting: The spine and joint specialized hospital’s research center. Methods: We reviewed cases of percutaneous sacroplasty performed since 2009. We used data only from patients with osteoporotic SIFs who were followed for more than 12 months after sacroplasty. Tumor-related SIFs were excluded from our analysis. The following clinical parameters were investigated: initial diagnosis, symptoms, visual analog scale (VAS) of pain, functional mobility scale (FDC) score, past history of illness, amount of bone cement infused, and complications related to sacroplasty. Also, the following radiological parameters were analyzed: the pattern of SIFs, T-score cement leakage, and concomitant fractures in other sites. Results: Sixty-eight patients were enrolled in our study (4 men and 64 women). The mean age of the patients was 76.8 ± 6.2 years. All patients had severe osteoporosis (mean T score: -3.9 ± 0.5). Percutaneous sacroplasty was performed under fluoroscopic guidance. No major complications or procedure-related morbidity occurred. FDS and VAS scores significantly improved after sacroplasty, and the improvements lasted through the final follow-up period (P &lt; 0.05). Limitations: This study is a retrospective analysis without a control group. Conclusion: Percutaneous sacroplasty is an effective minimally invasive treatment for osteoporotic SIFs refractory to conservative management. The study patients experienced significant relief of pain and increased mobility. Key words: Sacrum, sacroplasty, insufficiency fractures, osteoporosis, minimally invasive surgery

Effects of Percutaneous Sacroplasty on Pain and Mobility in Sacral Insufficiency Fracture.

ObjectiveSacral insufficiency fracture (SIF) contributes to severe low back pain. Prolonged immobilization resulting from SIF can cause significant complications in the elderly. Sacroplasty, a treatment similar to vertebroplasty, has recently been introduced for providing pain relief in SIF. The purpose of this study is to investigate the clinical short-term effects of percutaneous sacroplasty on pain and mobility in SIF.MethodsThis study is conducted prospectively with data collection. Sixteen patients (3 men and 13 women) with a mean age of 77.5 years (58 to 91) underwent sacroplasty. Patients reported visual analogue scale (VAS; 0–10) and Oswestry disability index (ODI; 0–100%) scores. VAS and ODI scores were collected preoperatively and again at one day, one month, and three months postoperatively. Questionnaires measuring six activities of daily living (ADLs) including ambulating, performing housework, dressing, bathing, transferring from chair, and transferring from bed were collected. Ability to perform ADLs were reported preoperatively and again at three months postoperatively.ResultsThe mean preoperative VAS score (mean±SD) of 7.5±0.8 was significantly reduced to 4.1±1.6, 3.3±1.0, and 3.2±1.2 postoperatively at one day, one month, and three months, respectively (p<0.01). The mean ODI score (%) also significantly improved from 59±14 preoperatively to 15.5±8.2 postoperatively at one month and 14.8±8.8 at three months (p<0.01). All ADL scores significantly improved at three months postoperatively (p<0.01).ConclusionPercutaneous sacroplasty alleviates pain quickly and improves mobility and quality of life in patients treated for SIF.

Percutaneous sacroplasty for sacral fracture by osteoporotic insufficiency

Percutaneous sacroplasty for sacral fracture by osteoporotic insufficiency

Percutaneous Sacroplasty under Fluoroscopic Guidance Combined with Epidurogram for Sacral Insufficiency Fracture Resulting from Metastatic Tumor and Osteoporosis

Sacral insufficiency fracture resulting from a metastatic tumor or an osteoporotic fracture causes severe low back pain and radiating pain mass effect on neural foramen and chemical irritants. Percutaneous sacroplasty is one of the effective treatment modalities for sacral insufficiency fracture and its pain. Because of the structural complexity of the sacrum, obtaining an epidurogram of the S1 and S2 nerve roots before the start of the procedure can be helpful to avoid nerve injury. We present 2 successful cases of percutaneous sacroplasty performed under fluoroscopic guidance. A 65-year-old man with sacral metastasis from stomach cancer and a 52-year-old man with sacral insufficiency fracture were suffering from severe buttock pain and radiating pain. After epidurography of the S1 and S2 nerve roots with steroid and contrast dye, percutaneous sacroplasty with fluoroscopy on the S1 or S2 body and alae was performed on both patients. There was no cement leakage or any other major complications. Both patients experienced significant reduction in pain. Key words: Fluoroscopy-guided, sacral cementoplasty, sacral insufficiency fractures, sacral metastasis

Treatment of sacral aneurysmal bone cyst with percutaneous sacroplasty

Treatment of sacral aneurysmal bone cyst with percutaneous sacroplasty