Sacroplasty by CT and fluoroscopic guidance: is the procedure right for your patient?
OBJECTIVE
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.


CONCLUSIONS
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.
Strub
W M
WM
Department of Radiology, University of Cincinnati, Cincinnati, Ohio 45267, USA. williamstrub@hotmail.com
Hoffmann
M
M
Ernst
R J
RJ
Bulas
R V
RV
D000368:Aged; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D001843:Bone Cements; D005260:Female; D005471:Fluoroscopy; D005598:Fractures, Spontaneous / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D019904:Polymethyl Methacrylate / Q000008:administration & dosage*; D015642:Radiology, Interventional; D012447:Sacrum / Q000187:drug effects / Q000293:injuries* / Q000473:pathology; D016103:Spinal Fractures / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D001843:Bone Cements; D019904:Polymethyl Methacrylate