Abstract
Our aim was to assess the clinical outcome of patients who were subjected to long-axis sacroplasty for the treatment of sacral insufficiency fractures. Nineteen patients with unilateral (n = 3) or bilateral (n = 16) sacral fractures were involved. Under local anaesthesia, each patient was subjected to CT-guided sacroplasty using the long-axis approach through a single entry point. An average of 6 ml of polymethylmethacrylate (PMMA) was delivered along the path of each sacral fracture. For each individual patient, the Visual Analogue pain Scale (VAS) before sacroplasty and at 1, 4, 24 and 48 weeks after the procedure was obtained. Furthermore, the use of analgesics (narcotic/non-narcotic) along with the evolution of post-interventional patient mobility before and after sacroplasty was also recorded. The mean pre-procedure VAS was 8 ± 1.9 (range, 2 to 10). This rapidly and significantly (P < 0.001) declined in the first week after the procedure (mean 4 ± 1.4; range, 1 to 7) followed by a gradual and significant (P < 0.001) decrease along the rest of the follow-up period at 4 weeks (mean 3 ± 1.1; range, 1 to 5), 24 weeks (mean 2.2 ± 1.1; range, 1 to 5) and 48 weeks (mean 1.6 ± 1.1; range, 1 to 5). Eleven (58%) patients were under narcotic analgesia before sacroplasty, whereas 8 (42%) patients were using non-narcotics. Corresponding values after the procedure were 2/19 (10%; narcotic, one of them was on reserve) and 10/19 (53%; non-narcotic). The remaining 7 (37%) patients did not address post-procedure analgesic use. The evolution of post-interventional mobility was favourable in the study group as they revealed a significant improvement in their mobility point scale (P < 0.001). Long-axis percutaneous sacroplasty is a suitable, minimally invasive treatment option for patients who present with sacral insufficiency fractures. More studies with larger patient numbers are needed to explore any unrecognised limitations of this therapeutic approach.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Whitlow CT, Mussat-Whitlow BJ, Mattern CW, Baker MD, Morris PP (2007) Sacroplasty versus vertebroplasty: comparable clinical outcomes for the treatment of fracture-related pain. AJNR Am J Neuroradiol 28:1266–1270
Tjardes T, Paffrath T, Baethis H, Shafizadeh S, Steinhausen E, Steinbuechel T et al (2008) Computer assisted percutaneous placement of augmented iliosacral screws: a reasonable alternative to sacroplasty. Spine 33:1497–1500
Hinsche AF, Giannoudis PV, Smith RM (2002) Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res 395:135–144
Templeman D, Schmidt A, Freese J et al (1996) Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res 329:194–198
Sciubba DM, Wolinsky JP, Than KD, Gokaslan ZL, Witham TF, Murphy KP (2007) CT fluoroscopically guided percutaneous placement of transiliosacral rod for sacral insufficiency fracture: case report and technique. AJNR Am J Neuroradiol 28:1451–1454
Masala S, Mastrangeli R, Petrella MC, Massari F, Ursone A, Simonetti G (2009) Percutaneous vertebroplasty in 1,253 levels: results and long-term effectiveness in a single centre. Eur Radiol 19(1):165–171
Pitton MB, Herber S, Koch U, Oberholzer K, Drees P, Düber C (2008) CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures. Eur Radiol 18:2568–2578
Pitton MB, Morgen N, Herber S, Drees P, Böhm B, Düber C (2008) Height gain of vertebral bodies and stabilization of vertebral geometry over one year after vertebroplasty of osteoporotic vertebral fractures. Eur Radiol 18:608–615
Binaghi S, Guntern D, Schnyder P, Theumann N (2006) A new, easy, fast, and safe method for CT-guided sacroplasty. Eur Radiol 16:2875–2878
Heron J, Connell DA, James SL (2007) CT-guided sacroplasty for the treatment of sacral insufficiency fractures. Clin Radiol 62:1094–1003
Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E (2003) Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine 70:287–289
Frey ME, Depalma MJ, Cifu DX, Bhagia SM, Carne W, Daitch JS (2008) Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J 8:367–373
Frey ME, DePalma MJ, Cifu DX, Bhagia SM, Daitch JS (2007) Efficacy and safety of percutaneous sacroplasty for painful osteoporotic sacral insufficiency fractures: a prospective, multicenter trial. Spine 32:1635–1640
Strub WM, Hoffmann M, Ernst RJ, Bulas RV (2007) Sacroplasty by CT and fluoroscopic guidance: is the procedure right for your patient? AJNR Am J Neuroradiol 28:38–41
Butler CL, Given CA 2nd, Michel SJ, Tibbs PA (2005) Percutaneous sacroplasty for the treatment of sacral insufficiency fractures. AJR Am J Roentgenol 184:1956–1959
Smith DK, Dix JE (2006) Percutaneous sacroplasty: long-axis injection technique. AJR Am J Roentgenol 186:1252–1255
Acknowledgements
The authors gratefully acknowledge the technical assistance of Martine Bernasconi, and Martial Narbel. Part of this work was presented at the 96th Annual Meeting of the Swiss Society of Radiology, Geneva, Switzerland, June 04-06, 2009.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kamel, E.M., Binaghi, S., Guntern, D. et al. Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures. Eur Radiol 19, 3002–3007 (2009). https://doi.org/10.1007/s00330-009-1486-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-009-1486-3