Sacral radiculopathy due to cement leakage from percutaneous sacroplasty, successfully treated with surgical decompression

Radmer²,

et al. 2017

Eur Spine J

Purpose The objective of this prospective, randomised study was to examine the feasibility and clinical outcome of balloon sacroplasty and radiofrequency sacroplasty. Methods In 40 patients with a total of 57 sacral fractures, CT-guided cement augmentation was performed by means of BSP or RFS. For BSP, the balloon catheter was inflated and deflated in the fracture zone, and the hollow space, thus, created was then filled with PMMA cement. For RFS, the spongious space in the fracture zone was initially extended using a flexible osteotome, and the highly viscous PMMA cement, activated by radiofrequency, was then inserted into the prepared fracture zone. Pain intensity was determined on a VAS before the intervention, on the second day, and 6, 12 and 18 months after the intervention. The results were tested for significance by means of paired Wilcoxon rank-sum tests and Mann-Whitney U tests. Results BSP and RFS were technically fully feasible in all patients. An average of 6.3 ml cement per fracture was inserted in the BSP group and an average of 6.1 ml per fracture in the RFS group. Leakage could be ruled out for both procedures. The mean pain score on the VAS before the intervention was 8.6 ± 0.55 in the BSP group and 8.8 ± 0.58 in the RFS group. On the second postoperative day, a significant pain reduction was seen (p \ 0.001), with an average value of 2.5 (BSP ± 0.28, RFS ± 0.38) for both groups. After 6 (12; 18) months, these values were stable for the BSP group at 2.3 ± 0.27 (2.3 ± 0.24; 2.0 ± 0.34) and for the RFS group at 2.4 ± 0.34 (2.2 ± 0.26; 2.0 ± 0.31). With regard to pain, exceedance probability values of p = 0.86 (6 months), p = 0.94 (12 months) and p = 1 (18 months) were seen, so that neither treatment method leads to differences in results. Conclusions BSP and RFS are interventional, minimally invasive procedures that enable reliable cement augmentation and achieve equally good clinical outcomes in the medium term.

Section: Discussionmentioning

confidence: 99%

Comparison of the 18-month outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study

Radmer²,

et al. 2017

Eur Spine J

“…Using a balloon catheter, a central cavity is created in the lesion for the introduction of the cement, whereby a compaction of peripheral tumor tissue and the adjacent pathological fracture zone closes possible fissures [8], and thus makes it more difficult for cement to leak in the direction of the neuroforamina, iliosacral joints and visceral surface of the sacrum. Reduction of cement leakages represents an advantage of sacro-kyphoplasty [3, 9] over sacro-vertebroplasty [22,23] in patients with insufficiency fractures as well as in patients with osseus destruction. Leakages can cause severe complications such as radiculopathies with strong pain, which in the worst case have to be treated with surgical decompression [23].…”

Section: Abb 1 Illustration Der Möglichen Zugangswege Zur Erreichungmentioning

confidence: 99%

“…Reduction of cement leakages represents an advantage of sacro-kyphoplasty [3, 9] over sacro-vertebroplasty [22,23] in patients with insufficiency fractures as well as in patients with osseus destruction. Leakages can cause severe complications such as radiculopathies with strong pain, which in the worst case have to be treated with surgical decompression [23].…”

Section: Abb 1 Illustration Der Möglichen Zugangswege Zur Erreichungmentioning

confidence: 99%

Balloon Sacroplasty as a Palliative Pain Treatment in Patients with Metastasis-Induced Bone Destruction and Pathological Fractures

Radmer²,

Lüdtke

et al. 2014

Fortschr Röntgenstr

Purpose: In the case of metastatic involvement of the sacrum with destruction and consecutive pathological fracture, intense disabling pain is one of the defining factors. The feasibility, safety and pain development with cement augmentation were to be investigated. Materials and Methods: CT-guided balloon sacroplasty was conducted in 10 patients with metastasis-induced bone destruction of the sacrum. After establishment of the entry point, a K-wire was first introduced as far as the central tumor lesion via the short, or transiliac axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times. The PMMA cement was then injected into the preformed cavity. The procedure was completed by a spiral CT control using the thin-slice technique. Pain intensity was determined using a visual analog scale (VAS) before the procedure, on the 2nd postoperative day and 6 months after the intervention. Finally, the patients were asked to state how satisfied they were. Results: Balloon sacroplasty was technically feasible in all patients. The control CT scan showed central distribution of the cement in the tumor lesion. On average 6?+/??1.78 (4???10) ml of PMMA cement were introduced per treated lesion. A significant (p?

Current Orthopaedic Practice

“…12 Injection of PMMA cement into SIF also has been reported to result in complications from cement leakage resulting in neurologic radiculopathy requiring treatment or surgical nerve decompression. 13,14 Prokop et al 15 reported significantly higher rates of cement extravasation during fluoroscopic PS when compared to CT guided procedures.…”

Section: Sacroplastymentioning

confidence: 96%

Diagnosis and management of sacral insufficiency fractures

Scolaro

Zamorano

2016

Sacral insufficiency fractures are pathologic fractures that occur in patients with abnormal bone quality. These injuries occur after low-energy trauma or repetitive physiologic loads. Historically, treatment of sacral insufficiency fractures was nonoperative with modified weightbearing and analgesia. Increased awareness to the potential morbidity and mortality associated with these injuries has led to multiple proposed interventions. Percutanous sacroplasty and screw fixation are the two most frequently performed procedures for sacral insufficiency fractures and involve placement of cement or screws, respectively, within the sacrum to stabilize these lesions. Although there is published literature to support both treatments, a validated classification system to describe sacral insufficiency fractures and comparative clinical data do not exist. The optimal treatment for sacral insufficiency fractures is dependent on the location, size, and chronicity of the lesion; consideration should also be given to the entire pelvic ring and contribution of the sacral insufficiency fracture to the stability of the bony pelvis.