American Journal of Neuroradiology 28:38-41, January 2007
© 2007 American Society of Neuroradiology
SPINE
Sacroplasty by CT and Fluoroscopic Guidance: Is the Procedure Right for Your Patient?
a Department of Radiology, University of Cincinnati, Cincinnati, Ohio
b Department of Radiology, The Christ Hospital, Cincinnati, Ohio
Address correspondence to William M. Strub, MD, Department of Radiology, University of Cincinnati, 234 Goodman St, ML 0761, Cincinnati, OH 45267; e-mail: williamstrub{at}hotmail.com
BACKGROUND AND PURPOSE: Sacral insufficiency fractures are an infrequent but often disabling cause of severe low back pain. We report our results of a sacroplasty technique, using CT for needle placement and fluoroscopy to monitor the polymethylmethacrylate injection in a group of patients with sacral insufficiency fractures.
METHODS: All patients had a history of chronic back pain and had an osteoporotic sacral insufficiency fracture documented by imaging before the procedure. With the patient under conscious sedation, a bone biopsy needle was placed under CT guidance; the patient was then transferred to the fluoroscopy suite, where a polymethylmethacrylate mixture was injected into the sacrum under real-time fluoroscopy. Clinical outcome was assessed by telephone.
RESULTS: The procedure was performed on 13 female patients with an average age of 76 years (range, 60–88 years). A bilateral procedure was performed in 11 patients and a unilateral procedure was performed in 2 patients. An average of 4.1 mL of cement was injected for each treatment. There were no instances of cement extravasation into the central canal or sacral foramina. Long-term follow-up, averaging 15 months, was available in 6 patients. Five patients (83%) reported no symptoms of pain at all. The final patient, in whom a bilateral procedure was performed, was completely asymptomatic on the left side but reported persistent unilateral pain on the right.
CONCLUSION: Sacroplasty is a safe and effective procedure in the treatment of sacral insufficiency fractures that can provide substantial pain relief and lead to a better quality of life.