Balloon kyphoplasty for treatment of sacral insufficiency fractures

Abstract

<jats:p>Sacral insufficiency fracture is a painful injury, for which no effective treatment currently exists. The objective of this study was to report on the clinical outcomes and technical aspects of balloon kyphoplasty, which was used in three patients with this injury.</jats:p> <jats:p>Three elderly women with intractable pain from sacral insufficiency fractures were treated with polymethyl methacrylate (PMMA) injections into the sacrum by using a modified balloon kyphoplasty procedure. The visual analog scale pain score improved by four points in each case. Functional status was improved and analgesic medication requirements were decreased in all three patients. There were no complications associated with the procedure.</jats:p> <jats:p>Because of the unique anatomy of the sacrum, it was difficult to monitor instrument placement and PMMA injection by using conventional fluoroscopy. BrainLAB image guidance was used in one case, and was helpful in guiding instrument placement and assuring accurate PMMA deposition at the fracture site.</jats:p> <jats:p>Balloon kyphoplasty may be a treatment alternative in selected patients with sacral insufficiency fractures. BrainLAB image guidance may offer some advantages over conventional fluoroscopy with regard to the monitoring of instrument placement and PMMA injection.</jats:p>

Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature

“…The average VAS improved from a pre-operative score of 8.9 to 2.6 post-operatively [4,6,9,11,16,25]. This is statistically significant (P \ 0.001, paired Student's t test).…”

“…Subsequent studies that have used the short-axis approach have utilised 4-20 ml of cement in total, across unilateral or bilateral fractures. Butler et al [7] described using 4-8 ml per side, with Pommersheim et al [23] and Deen and Nottmeier [9] using between 2 and 6 ml per side. Heron et al [16] injected 4 ml per fracture and Frey et al [11] 2-5 ml per vertebral level.…”

“…There was a statistically significant improvement in pain scores in both groups (61.5% after sacroplasty, 61.8% after vertebroplasty) with no significant difference between the two. Complications reported so far have included clinically insignificant cement leakage into the S1 foramen in one case [16], posteriorly in one case [23], into the sacroiliac joint [7], anteriorly in four patients [9,26] and intravenously in one case [7]. Frey et al [11] describe the development of an S1 radiculopathy during the procedure, at which point they stopped injecting cement, although they did not clarify whether the cement had extravasated.…”

“…However, the risks and benefits of this procedure are not yet fully understood. Sacroplasty remains an evolving technique and numerous methods have been described in the form of technical reports with accompanying case reports or small case series [4,6,7,9,11,12,14,16,19,23,[25][26][27][28]30]. So far, no consensus has been agreed with regard to best practise.…”

Sacroplasty in a cadaveric trial: comparison of CT and fluoroscopic guidance with and without balloon assistance

“…Furthermore, the created void allows the use of an exact defined amount and highly viscous bone cement with a lower risk for extravasation. The balloon kyphoplasty has been previously described for the treatment of SIFs with good results [13].…”