Percutaneous Sacroplasty for Painful Sacral Metastases Involving Multiple Sacral Vertebral Bodies: Initial Experience with an Interpedicular Approach

OBJECTIVE: To report our initial experience of percutaneous sacroplasty (PSP) with an interpedicular approach for treating painful sacral metastases involving multiple sacral vertebral bodies. MATERIALS AND METHODS: This study prospectively enrolled 10 consecutive patients (six men and four women; mean age, 56.3 ± 13.8 years) who underwent PSP for painful sacral metastases involving multiple sacral vertebral bodies from March 2017 to September 2018. Visual analogue scale (VAS) scores, Oswestry disability index (ODI) values, and the number of opioids prescribed to the patients were assessed before and after PSP. The procedure duration, length of hospitalization, and complications were also recorded. RESULTS: Mean VAS and ODI declined significantly from 6.90 ± 1.20 and 74.40 ± 5.48 before the procedure to 2.70 ± 1.34 and 29.60 ± 14.57 after the procedure, respectively (p < 0.01). The median number of opioids prescribed per patient decreased from 2 (interquartile range [IQR] 1-3) pre-procedure to 1 (IQR 0–3) post-procedure (p < 0.01). Nine of the 10 patients showed no or decreased opioid usage, and only 1 patient showed unchanged usage. The mean procedure duration was 48.5 ± 3.0 minutes. The average length of hospitalization was 4.7 ± 1.7 days. Extraosseous cement leakage occurred in three cases without causing any clinical complications. CONCLUSION: PSP with an interpedicular approach is a safe and effective treatment in patients with painful sacral metastases involving multiple sacral vertebral bodies and can relieve pain and improve mobility.

Transiliac sacroplasty for Denis 3 fracture: Two cases report

We present two cases of percutaneous sacroplasty for sacral body fracture (Denis 3) and sacral alar fracture under multislice computed tomography (MSCT) guidance and discuss the clinical results and technical considerations. Sacroplasty is often recommended for the treatment of painful sacral insufficiency fractures, which destabilize the sacrum. However, sacroplasty for Denis zone 3 is rare because of the lack of validating controlled studies or unique technical considerations related to sacral anatomy. We performed sacroplasty for Denis zone 3 via the transiliac approach. Precise needle placement and polymethylmethacrylate cement injection were performed safely under the MSCT system. No complications occurred related to this procedure, such as iliac fracture, vascular leakage, or epidural leakage. MSCT-guided transiliac sacroplasty was a useful and effective solution in treating sacral body fracture.

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

OBJECTIVE: Sacral insufficiency fracture (SIF) contributes to severe low back pain. Prolonged immobilization resulting from SIF can cause significant complications in the elderly. Sacroplasty, a treatment similar to vertebroplasty, has recently been introduced for providing pain relief in SIF. The purpose of this study is to investigate the clinical short-term effects of percutaneous sacroplasty on pain and mobility in SIF. METHODS: This study is conducted prospectively with data collection. Sixteen patients (3 men and 13 women) with a mean age of 77.5 years (58 to 91) underwent sacroplasty. Patients reported visual analogue scale (VAS; 0–10) and Oswestry disability index (ODI; 0–100%) scores. VAS and ODI scores were collected preoperatively and again at one day, one month, and three months postoperatively. Questionnaires measuring six activities of daily living (ADLs) including ambulating, performing housework, dressing, bathing, transferring from chair, and transferring from bed were collected. Ability to perform ADLs were reported preoperatively and again at three months postoperatively. RESULTS: The mean preoperative VAS score (mean±SD) of 7.5±0.8 was significantly reduced to 4.1±1.6, 3.3±1.0, and 3.2±1.2 postoperatively at one day, one month, and three months, respectively (p<0.01). The mean ODI score (%) also significantly improved from 59±14 preoperatively to 15.5±8.2 postoperatively at one month and 14.8±8.8 at three months (p<0.01). All ADL scores significantly improved at three months postoperatively (p<0.01). CONCLUSION: Percutaneous sacroplasty alleviates pain quickly and improves mobility and quality of life in patients treated for SIF.

Sacroplastia: una nueva esperanza para el dolor por metástasis sacra / Sacroplasty: new hope for pain from sacral metastasis

La cementoplastía en aplastamientos o fracturas vertebrales es un proceder que se utiliza con mayor frecuencia en la sociedad moderna, basado en la inyección percutánea de polimetil-metacrilato. El objetivo de este artículo es presentar una experiencia de nuevo abordaje en el tratamiento del dolor oncológico; en este caso por metástasis en el cuerpo vertebral de S2, a partir de un cáncer de próstata, que refería un dolor incapacitante. Creemos que el proceder fue novedoso y que existen pocos casos reportados en la bibliografía mundial sobre la sacroplastia.

The cementoplasty in squashing or vertebral fractures is an action that is utilized with high frequency in the modern society, based in the percutaneous injection of polimetil-metacrylate. The objective of this presentation is to show you an experience to a new perspective in the treatment of the cancer pain; In this case for metastasis in S2's vertebral body, from a prostate cancer, that presented a crippling pain. That is why we thought the way it was conducted was innovative and there are few cases that have been reported in the worldwide bibliography on the sacroplasty.

Therapeutic Considerations of Percutaneous Sacroplasty for the Sacral Insufficiency Fracture

Sacral insufficiency fracture is a debilitating injury not easily found in general radiologic examinations and is rarely diagnosed, since its symptoms are obscure. It is known to frequently occur in patients with osteoporosis, but the treatment has not yet been established and various kinds of treatment methods are being attempted. Sacroplasty is sometimes performed by applying percutaneous vertebroplasty which is known to be a less invasive treatment. Since the course of diagnosis of sacral insufficiency fracture is difficult and clear guidelines for treatments have not yet been established, many spine surgeons fail to diagnose patients or speculate on treatment methods. We report our experience in diagnosing a sacral insufficiency fracture in a 54-year-old healthy female patient using MRI and treating her with sacroplasty. From a therapeutic point of view, we then cover the usefulness, effects and characteristics relating to the complications of sacroplasty, along with literature review.

Percutaneous Sacroplasty for the Sacral Insufficiency Fracture Caused by Metastasis / 대한통증학회지

Insufficiency fractures of the sacrum are relatively common and cause severe low back and buttock pain. Percutaneous vertebroplasty is effective for treating vertebral compression fractures. We present a case of percutaneous sacroplasty for the treatment of low back and buttock pain in a sacral insufficiency fracture. A 79-year-old male with non-small lung cancer presented with severe low back and buttock pain after series of radiation treatments. Preoperative MRI showed both a sacral ala and S2 metastatic insufficiency fracture. An epidural port was inserted for continuous morphine infusion and sacral nerve root blocks were performed. However, his pain did not diminish and we attempted percutaneous sacroplasty. Both sides of the sacroplasty were done with a fluoroscopy-guided technique with 1.7 ml and 2.3 ml of bone cement injected into the right and left sacral ala. Pain relief was significant and the patient was able to sit down 1 day after the procedure.

Percutaneous Sacroplasty for Sacral Metastatic Tumors Under Fluoroscopic Guidance Only

Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.

Percutaneous sacroplasty / 介入放射学杂志

Percutaneous sacroplasty is a technique, derived from percutaneous vertebroplasty, with minimal invasion and better safety for refractory sacroiliac pain. The procedure is involved with bone cement injected into the diseased sacral body under fluoroscopic or computed tomography guidance and in turn for stabilizing and strengthening the vertebral body with outcome of decrease or even complete relief of pain. The author introduces and comprehends the definition, preoperative imaging examinations, indications, contraindications, techniques and complications of the procedure.