SACROPLASTY SACRAL INSUFFICIENCY FACTURE TREATMENT

SACROPLASTY FOR SACRAL INSUFFICIENCY FRACTURES

Sacral insufficiency fractures are underdiagnosed, which could lead to long-term pain and disability and their prevalence is likely underestimated. 

Often Difficult to Diagnose1

  • Sacral anatomy is poorly delineated on routine sacral X-rays.
  • Patient often lacks a definitive history of trauma.

Prevalence Likely Underestimated1

  • 1.8% of women over the age of 55 years who presented to the hospital with low back pain had sacral fractures.

Potential Cost of Care is High1

  • Under diagnosis may lead to long-term pain and disability.
  • Inpatient length-of-stay and prolonged disability can further augment cost of patient rehabilitation.

HOW SACROPLASTY WORKS FOR SACRAL INSUFFICENCY FRACTURES

Sacroplasty is a minimally invasive procedure for treating pathological fractures of the sacral vertebral body or sacral ala. The goal of sacroplasty is to relieve pain and stabilize the fracture.1

The sacroplasty procedure involves:

  • Percutaneously inserting one or more bone needles into the sacrum under fluoroscopy and/or CT visual guidance
  • Injecting bone cement under imaging to stabilize the fracture

TWO SURGICAL APPROACHES

There are two primary access approach options for sacroplasty – short and long-axis to account for factors like fracture location and desired cement placement. 

Bi-Lateral Short-Axis Sacroplasty

Illustrated image of the sacroplasty short-axis technique

Bi-Lateral Long-Axis Sacroplasty

Illustrated image of the Sacroplasty long axis technique

SACROPLASTY PROCEDURE DEMONSTRATIONS

SHORT-AXIS TECHNIQUE

Watch Labib Haddad, MD, demonstrate how to perform sacroplasty using the short-axis technique (20:25).
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LONG-AXIS TECHNIQUE

Watch Labib Haddad, MD, demonstrate how to perform sacroplasty using the long-axis technique (15:02).
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CLINICAL OUTCOMES

PAIN RELIEF SEEN IN SOME PATIENTS WITHIN 30 MINUTES3

In a prospective observational cohort study, sacroplasty provided rapid pain relief within 30 minutes of the procedure. Reduction in pain levels continued to 52 weeks.

Post-procedure mean scores: repeated measure analysis of variance (p < 0.01).

Study Design

  • Prospective observational cohort study of consecutive patients with osteoporotic sacral insufficiency (SI)
  • n = 52
  • Mean age: 75.9 years
  • Mean symptom duration: 34.5 days

Study Notes

  • Patients attended each follow-up interval. (Exception: One patient died after the 2-week follow-up from unrelated pulmonary disease.)
  • One case of SI radiculitis occurred due to cement extravasation. This resolved with a single transforaminal epidural steroid injection.

Limitations

  • Randomized controlled trials are needed to evaluate the efficacy of sacroplasty for osteoporotic SI, and to provide an accurate estimate of associated risks.
Illustrated chart displaying results from a Sacroplasty study

SIGNIFICANT IMPROVEMENT IN PAIN SCORES AFTER SACROPLASTY2

In a retrospective multicenter analysis, CT-guided sacroplasty provided prompt and durable pain relief in patients with SIFs and sacral lesions. The drop-in pain scores were significant for all groups (P < 0.001).

Fracture Type or Lesion

Pre-treatment  
VAS Score (avg)

Post-treatment  
VAS Score (avg) 

P value  

Bilateral sacral insufficiency fracture 

9.2 

1.9 

< 0.001 

Unilateral sacral insufficiency fracture 

8.7 

2.5 

< 0.001 

Sacral mass or infiltrative lesion 

9.0 

2.6 

< 0.001 

Study Design

  • A retrospective multicenter analysis of consecutive patients with painful SI fractures or lesions
  • n = 204 – SI fracture
  • n = 39 – Sacral lesion
  • Mean age: 77.2 years

Study Notes

  • Complete pain relief was achieved in 31% of patients.
  • The average cement volume used to treat SI fractures was 4.1 ml.* No major complications or procedure-related deaths occurred. One patient treated for an SI fracture experienced radicular pain due to local foraminal cement extravasation. Surgical decompression provided symptomatic relief
  • One patient had an unsuccessful sacroplasty procedure with subsequent progressive fracture dislocation.

Limitations

  • Limitation: Randomized controlled trials are needed to evaluate the efficacy of sacroplasty for osteoporotic SI, and to provide an accurate estimate of associated risks.

BALLOON KYPHOPLASTY PLATFORM

Kyphon™ balloon kyphoplasty is a minimally invasive treatment for vertebral compression factures. Learn more about kyphoplasty products.

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SACROPLASTY  REIMBURSEMENT 

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1

Ortiz AO and Brook AL. Sacroplasty. Tech Vasc Interv Radiol. 2009;12(1):51-63. doi: 10.1053.

2

Kortman K, Ortiz O, Miller T, et al. Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions. J Neurointerv Surg. 2013;5(5):461-466

3

Frey M, DePalma M, Cifu D, et al. Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J. 2008;8(2):367-373.

*

Two patients treated with bioceramic bone cement experienced significant pain relief. This number is insufficient to make a conclusion about bioceramic cement in this procedure.