Sacral kyphoplasty for the treatment of painful sacral insufficiency fractures and metastases

Shah, Rinoo V.

doi:10.1016/j.spinee.2012.01.019

Cited by 42 publications

(25 citation statements)

References 42 publications

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“…Since a rapid analgesic effect with a positive effect on mobility and the activities of daily living has been repeatedly shown after sacroplasty [4,8,9,11,13,14], this therapeutic option should be taken after an unsuccessful attempt at conservative treatment with persistent disabling pain. Cement augmentation analogous to vertebroplasty [8][9][10] or balloon kyphoplasty [4,9,11,13,14] come into question here. Greater clinical experience has been gained in cement insertion via a placed hollow needle in accordance with vertebroplasty, although higher rates of cement leakage are experienced here, as in the treatment of vertebral body fractures [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Greater clinical experience has been gained in cement insertion via a placed hollow needle in accordance with vertebroplasty, although higher rates of cement leakage are experienced here, as in the treatment of vertebral body fractures [9,10]. A central cavity for insertion of the cement can be created using a balloon catheter, whereby a compaction of the surrounding fracture zone seals possible fracture fissures and thus minimises cement leakage [4,[12][13][14]. On the basis of good clinical experience [20,21] with regard to pain reduction, a low rate of leakage and vertebral body reconstruction with highly viscous cement insertion by means of radiofrequency kyphoplasty on the spine and initial good results after RFS with regard to pain reduction Pain development before and after the RFS.…”

Section: Discussionmentioning

confidence: 99%

“…Sacroplasty with balloon dilatation, analogous to kyphoplasty, was first performed by Deen and Nottmeier [11] on three patients. The safe feasibility of CT-guided balloon sacroplasty was later confirmed in a cadaver study [12] and in various clinical studies [4,13,14]. For RFS, a case report [15] and initial investigations [16,17] have also shown good results with regard to pain reduction.…”

Section: Introductionmentioning

confidence: 93%

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Radiofrequency sacroplasty (RFS) for the treatment of osteoporotic insufficiency fractures

Andresen

Lüdtke

Radmer³

et al. 2014

Eur Spine J

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Introduction and objective In elderly patients with reduced bone quality, insufficiency fractures of the sacrum are relatively common and are typically accompanied by severe, disabling pain. The objective of this study was to evaluate the feasibility of cement augmentation by RFS, as well as to determine postinterventional leakages and present the patients' outcomes. Material and method In 20 patients (18 women, 2 men) with an average age of 80.4 (65-92) years, a fracture of the sacrum was detected by CT and MRI. Clinically manifest osteoporosis with QCT values of below 50 mg/ ml was found in all patients. An initially performed conservative treatment over a period of 3 weeks did not achieve a satisfactory reduction in the severe, disabling pain. The cement augmentation was performed under CT guidance by means of RFS under intubation anaesthesia. A Jamshidi needle was advanced into the respective fracture zone in the sacrum from dorsal to ventral (short axis) or from lateral to medial transiliac (transiliac axis).After removing the inner needle, a flexible osteotome was inserted through the positioned hollow needle and used to extend the spongious space in the fracture zone and thus prepare a cavity for the cement filling. The highly viscous polymethyl methacrylate (PMMA) cement, activated by radiofrequency, was then inserted into the prepared fracture zone through a substituted screw cannula. Cement filling was performed discontinuously under instrumental guidance at 1.3 ml/min under CT guidance. Cement leakages were determined in CT images and conventional X-rays on the day after the intervention. Pain was documented on a visual analogue scale (VAS) on the day before the intervention, on the second day, and after 6 and 12 months after the intervention. Additionally occurring complications were recorded, and the patients were asked to state how satisfied they were after 12 months. Results RFS was technically feasible in all patients. In the control CT scans and X-rays, sufficient cement distribution and interlocking with vital bone was found along the course of the fracture in the sacrum. 7.2 (4-9) ml of cement were inserted per fracture. Leakage could be ruled out. The mean pain score on the VAS was 8.8 ± 1.2 before the intervention, and a significant reduction in pain (p \ 0.001) was seen on the second postoperative day, with an average value of 2.3 ± 0.7, which was stable at 2.2 ± 1.3 after 6 months and 2.1 ± 1.1 after 12 months. All of the patients could be fully re-mobilised and discharged back home. A high level of patient satisfaction was found after 12 months, with 18 of the 20 patients stating that they would undergo the intervention again. One patient died of a stroke, another of cancer over the course. Conclusion As a minimally invasive procedure, RFS is an effective and safe method of treatment for rapid, significant and sustained pain reduction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

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Radiofrequency sacroplasty (RFS) for the treatment of osteoporotic insufficiency fractures

Andresen

Lüdtke

Radmer³

et al. 2014

Eur Spine J

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“…Conventional balloon kyphoplasty has been described for osteoporotic fractures [11,20,31], metastatic fractures [20], and a sacral hemangioma [32] Abb. 7 Postoperative Bildgebung (Patient 1).…”

Section: Clinical Outcomementioning

confidence: 99%

“…Cement extravasation during sacroplasty into paraspinal soft tissues, sacroiliac joints, neural foramen, and intravenously was reported. The extravasations were mostly described as asymptomatic [7,12,13,16,20,26,28,31,36]. However, transient L5 radiculopathy [36] and transient S1 radiculopathy [13,20] occurred.…”

Section: Cement Extravasationmentioning

confidence: 99%

First Experience Using Navigation-Guided Radiofrequency Kyphoplasty for Sacroplasty in Sacral Insufficiency Fractures

Klingler¹,

Kluge²,

Sircar³

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate the efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures. Methods: In this single-center retrospective observational study, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum. Results: Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3???0.5 to 2.3???1.0 (p?

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Interventional Techniques in Palliative Care

Shah¹,

Kaye

Merritt

et al. 2012

Essentials of Palliative Care

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Sacral kyphoplasty for the treatment of painful sacral insufficiency fractures and metastases

Cited by 42 publications

References 42 publications

Radiofrequency sacroplasty (RFS) for the treatment of osteoporotic insufficiency fractures

Radiofrequency sacroplasty (RFS) for the treatment of osteoporotic insufficiency fractures

First Experience Using Navigation-Guided Radiofrequency Kyphoplasty for Sacroplasty in Sacral Insufficiency Fractures

Interventional Techniques in Palliative Care

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