CT Fluoroscopically Guided Percutaneous Placement of Transiliosacral Rod for Sacral Insufficiency Fracture: Case Report and Technique

Abstract

SUMMARY:Treatment of sacral insufficiency fractures (SIFs) has traditionally been conservative, but several patients have been treated with percutaneous sacroplasty. Unfortunately, in the setting of severe, bilateral SIFs, cement may not withstand shear forces present at the lumbosacral junction, and surgical hardware may not provide adequate fixation in osteoporotic, cancellous bone of the sacrum, leading to eventual pseudarthrosis. Thus, we propose a novel technique in which guidance with CT fluoroscopy allows placement of a transiliosacral bar in conjunction with sacroplasty.

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).…”

“…Layton et al [19] described injecting 2 ml of cement per vertebral body instrumented, similar to that of Tjardes et al [28] and Frey et al [11]. Unfortunately, Brook et al [6], Smith and Dix [26] and Sciubba et al [25] did not comment on the amount of cement they injected despite describing their technique.…”

“…Sciubba et al [25] describe a technique where the transiliosacral rod is positioned through a lateral incision, before injection of the cement. Although they use different incisions and approaches to each step of their procedure, they do not specifically describe their approach to the sacral vertebrae when injecting the cement.…”

“…However, the majority of 'simple' sacroplasty procedures are being reported from departments of radiology [4,6,7,12,14,16,19,23,26,27,30], with only four papers originating from other departments (e.g. neurosurgery and orthopaedics) [9,11,25,28].…”

“…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.…”