Effects of Percutaneous Sacroplasty on Pain and Mobility in Sacral Insufficiency Fracture

Choi, Kyung-Chul; Shin, Seung-Ho; Lee, Jun Young; Shim, Hyeong-Ki; Park, Choon‐Keun

doi:10.3340/jkns.2016.0505.010

Cited by 15 publications

(8 citation statements)

References 31 publications

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“…In our collective, 94 patients received percutaneous sacroplasty in local anesthesia. In line with other study groups, sacroplasty remaines to be one of the most important treatment for the majority 5 , 14 , 15) .…”

Section: Discussionsupporting

confidence: 75%

Sacral Insufficiency Fractures : How to Classify?

Bakker

Hattingen

Stuetzer

2018

J Korean Neurosurg Soc

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ObjectiveThe diagnosis of insufficiency fractures of the sacrum in an elder population increases annually. Fractures show very different morphology. We aimed to classify sacral insufficiency fractures according to the position of cortical break and possible need for intervention.MethodsBetween January 1, 2008 and December 31, 2014, all patients with a proven fracture of the sacrum following a low-energy or an even unnoticed trauma were prospectively registered : 117 females and 13 males. All patients had a computer tomography of the pelvic ring, two patients had a magnetic resonance imaging additionally : localization and involvement of the fracture lines into the sacroiliac joint, neural foramina or the spinal canal were identified.ResultsPatients were aged between 46 and 98 years (mean, 79.8 years). Seventy-seven patients had an unilateral fracture of the sacral ala, 41 bilateral ala fractures and 12 patients showed a fracture of the sacral corpus : a total of 171 fractures were analyzed. The first group A included fractures of the sacral ala which were assessed to have no or less mechanical importance (n=53) : fractures with no cortical disruption (“bone bruise”) (A1; n=2), cortical deformation of the anterior cortical bone (A2; n=4), and fracture of the anterolateral rim of ala (A3; n=47). Complete fractures of the sacral ala (B; n=106) : parallel to the sacroiliac joint (B1; n=63), into the sacroiliac joint (B2; n=19), and involvement of the sacral foramina respectively the spinal canal (B3; n=24). Central fractures involving the sacral corpus (C; n=12) : fracture limited to the corpus or finishing into one ala (C1; n=3), unidirectional including the neural foramina or the spinal canal or both (C2; n=2), and horizontal fractures of the corpus with bilateral sagittal completion (C3; n=8). Sixty-eight fractures proceeded into the sacroiliac joint, 34 fractures showed an injury of foramina or canal.ConclusionThe new classification allowes the differentiation of fractures of less mechanical importance and a risk assessment for possible polymethyl methacrylate leaks during sacroplasty in the direction of the neurological structures. In addition, identification of instable fractures in need for laminectomy and surgical stabilization is possible.

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Section: Discussionsupporting

confidence: 75%

Sacral Insufficiency Fractures : How to Classify?

Bakker

Hattingen

Stuetzer

2018

J Korean Neurosurg Soc

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“…In particular, cement leakage with the risk of postoperative nerval lesion is to be mentioned. Numerous authors have demonstrated the low perioperative risk (especially with CT control) and the often asymptomatic perineural cement leakage 9 , 23 . In the patient material presented here there was one case of cement leakage, which led to a low-grade foot lift weakness of 4/5 after Janda.…”

Section: Discussionmentioning

confidence: 99%

Balloon-assisted sacroplasty as a successful procedure for osteoporotic sacral insufficiency fractures after failure of the conservative treatment

Schwetje

Wahd

Bornemann

et al. 2020

Sci Rep

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Osteoporotic vertebral fractures without prior adequate traumatization are frequent diagnosed in orthopedics because of the increasing life expectancy and incidence of osteoporosis. The associated high mortality is caused by reduced mobilization which leads to a higher risk of infection and a bedridden state. On the other hand the diagnosis of sacral insufficiency fractures is often prolonged because of unspecific symptoms while being associated with similar risks. This article presents an overview of the present scientific literature and a retrospective analysis of patients treated via balloon-assisted sacroplasty. In 8 years, ten patients (three men and seven women) were treated. The average age was 78.4 years and the average time until the diagnosis 4.6 weeks. In most patients a significant pain reduction after the failure of conservative treatment thanks to operative treatment as well as increased mobility was observed. Only one experienced a minor surgical complication being cement leakage with nerval impaction which did not compromise her clinical outcome or satisfaction with the procedure. Balloon-assisted sacroplasty can possibly be seen as an effective symptomatic therapy in osteoporotic insufficiency fractures.

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“…Anteroposterior 3) and lateral 4) radiographs that show the polymethylmethacrylate cement in the sacral wing without leakage. 6 Figure 5. Postoperative radiograph that shows bilateral sacroiliac screws and consolidation of the fracture of the pubis.…”

Section: Discussionmentioning

confidence: 99%

Pelvic Insufficiency: Underdiagnosed Condition, Therapeutic Diagnostic Review

García¹,

Estrada²,

Johnson³

2018

Coluna/Columna

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Objective: The importance of sacral fractures has recently been recognized. However, its diagnosis is difficult, both clinically and through image, but there are more options for comprehensive diagnosis. Methods: We conducted a literature review about its diagnosis and the treatments currently offered, and also to check which treatments had the best results. Results: Patients with pelvic insufficiency have limited mobility due to lumbar or pelvic pain. As radiculopathy is a neurologically stable condition, it has a reported incidence of only 5% and sphincter disorders. The pain improves when lying down and increases with load. The treatments vary from conservative to surgical. Discussion: The different treatments were compared, and the one that has more morbidity is the conservative, because it predisposes us to complications (pneumonia, pulmonary embolism, deep vein thrombosis, heart failure, decubitus ulcers); in the interventionists we observe a faster improvement to normal activity of these patients, the complications are minor and the pain improvement is noticeable and much faster. Conclusion: Fractures due to pelvic insufficiency are underdiagnosed. However, there are already better imaging techniques and combined with good exploration and clinical history we can suspect this condition and offer the best possible treatment, these being the invasive ones that have had better results with lower morbidity and recovery of activity much more quickly. Level of Evidence III; Review of therapeutic studies -Investigation of treatment results.Keywords: Fracture; Pelvis; Diagnosis; Therapeutics. RESUMO

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Effects of Percutaneous Sacroplasty on Pain and Mobility in Sacral Insufficiency Fracture

Cited by 15 publications

References 31 publications

Sacral Insufficiency Fractures : How to Classify?

Sacral Insufficiency Fractures : How to Classify?

Balloon-assisted sacroplasty as a successful procedure for osteoporotic sacral insufficiency fractures after failure of the conservative treatment

Pelvic Insufficiency: Underdiagnosed Condition, Therapeutic Diagnostic Review

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