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Sacroplasty: A Treatment for Sacral Insufficiency Fractures

William Pommersheima, Frank Huang-Hellingerb, Michael Bakera and Pearse Morrisa

a Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC
b Department of Radiology, Florida Hospital Medical Center, Orlando, FL



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  		FIG 1. Case 1, a 76-year-old woman with low back pain.

A, Pelvic radiograph shows degenerative lumbar changes. Note, however, that the sacrum is unremarkable.

B, Bone scan shows the H sign diagnostic of a sacral insufficiency fracture. Prominent renal activity on the scan is a normal finding.

C, Cortical disruption (arrows) on a non-contrast-enhanced pelvic CT scan confirms fracture.

D and E, Anteroposterior (D) and lateral (E) fluoroscopic images show cement in the L4 vertebral body and cement bilaterally in the sacral ala. The lateral view illustrates the difficulty with visualization within the sacrum during this technique.

F, Postoperative pelvic CT scan shows cement within the bilateral superior sacral ala in the vicinity of the fracture lines

G, Follow-up pelvic radiograph shows the cement within the superior sacrum



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  		FIG 2. Case 2, a 71-year-old woman with sacral insufficiency fracture.

A and B, Anteroposterior (A) and lateral (B) venograms do not clearly confirm needle tip placement within the sacrum. Again, notice the difficulty in confirming the needle tip location as being entirely intraosseous.

C and D, Anteroposterior (C) and lateral (D) fluoroscopic images show cement within the sacrum.

E, Postoperative pelvic CT scan shows cement within the left sacrum, but the right sacral injection has resulted in a portion of the cement being positioned within the posterior soft tissue



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  		FIG 3. Case 3, a 74-year-old woman with sacral insufficiency fracture.

A and B, Preoperative sacral MR images show low-T1 (A[TR/TE, 450/14]) and high-T2 (B[4000/99]) signal intensity, consistent with the edema from a sacral insufficiency fracture.

C, Pelvic CT scan illustrates the two intended needle paths, simplifying needle placement during sacroplasty.

D, Postoperative CT confirms cement location.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X