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.

Sequential Sacral Insufficiency Fracture After Unilateral Pubic Fractures: A Case Report

Osteoporotic fractures of the pelvic ring are not uncommon and among them sacral insufficiency fractures (SIFs) are often overlooked in patients with buttock or low back pain following no or minimal trauma, which results in diagnostic delays. SIFs are often bilateral and are commonly associated with other fractures - most frequently with a pubic ramus fracture. However, it remains unclear which fracture (sacral or pubic ramus) occurs first, and the only report on the subject found that the fracture sequence is initiated by a sacral fracture. The authors describe a case of sequential bilateral SIFs in a 74-year old woman following superior and inferior pubic rami fractures on one side. In conclusion we suggested that SIFs can occur after pelvic ring injury in any side because biomechanical disruption of the pelvic ring can induce the sacral fracture in patients with severe osteoporosis.

Sequential Sacral Insufficiency Fracture After Unilateral Pubic Fractures: A Case Report

Osteoporotic fractures of the pelvic ring are not uncommon and among them sacral insufficiency fractures (SIFs) are often overlooked in patients with buttock or low back pain following no or minimal trauma, which results in diagnostic delays. SIFs are often bilateral and are commonly associated with other fractures - most frequently with a pubic ramus fracture. However, it remains unclear which fracture (sacral or pubic ramus) occurs first, and the only report on the subject found that the fracture sequence is initiated by a sacral fracture. The authors describe a case of sequential bilateral SIFs in a 74-year old woman following superior and inferior pubic rami fractures on one side. In conclusion we suggested that SIFs can occur after pelvic ring injury in any side because biomechanical disruption of the pelvic ring can induce the sacral fracture in patients with severe osteoporosis.

Sacral Insufficiency Fracture with Osteoporotic Compression Fracture of the Thoracolumbar Spine : Incidence and High Risk Factors

OBJECTIVE: The sacral insufficiency fractures (SIFs) are not uncommon and usually occur in osteoporotic bone with minimal or unremembered trauma. Especially, if they are accompanied by osteoporotic compression fracture of the thoracolumbar spine, SIFs can be usually overlooked due to subtle clinical symptoms and signs coupled with radiographic findings. The review aims to be raising awareness of the incidence & risk factors of the SIFs. METHODS: We retrospectively reviewed the 252 patients who were admitted at our hospital due to osteoporotic compression fracture of the thoracolumbar spine with minimal or unremembered trauma for 5 years. We assessed the incidence of the SIF being accompanied by osteoporotic compression fracture of the thoracolumbar spine and the effects according to sex, age, probable risk factors (diabetes mellitus & arterial hypertension), the location of fracture and the severity of osteoporosis. RESULTS: 252 patients, including 36 men (14.3%) and 216 women (85.7%) were involved in this study and the osteoporotic compression fractures were located at thoracic (36 cases), thoracolumbar junction (180 cases), lumbar spine (36 cases). There are 18 cases (the incidence: 7.1%), including 2 men (5.5%) and 16 women (7.4%) in which the SIF was accompanied by osteoporotic compression fracture of the thoracolumbar spine. The effects according to sex, age, probable risk factors, the location of fracture and the severity of osteoporosis were not statistically different in both groups (group with SIF and group without SIF). CONCLUSION:The clinicians need to consider the possibility of SIF in patients of osteoporotic compression fracture of the thoracolumbar spine.

A Case of S1 Radiculopathy in Sacral Insufficiency Fracture without Fracture Line

Sacral insufficiency fractures are not uncommon cause of low back pain in elderly women with osteoporosis. The characteristics of sacral insufficiency fractures may not be related with neurological compromise. Their associated rate of neurological complication has been reported approximately 2%. The neurological complication, which is due to stretching or compression of nerve roots, is related with bony displacement. We present the case of an elderly women who developed S1 radiculopathy secondary to sacral insufficiency fracture with no evidence of fracture line.

Delayed Detection of Sacral Insufficiency Fractures

Many conditions may weaken bone and predispose to insufficiency fractures, including corticosteroids, radiation therapy, and rheumatoid arthritis, but osteoporosis is the main risk factor. Sacral insufficiency fractures (SIF) that usually present as nonspecific pelvic pain or low back pain are often overlooked in the elderly women with osteoporosis who have sustained minimal or no trauma. Diagnosis of SIF is difficult since the onset is mild, and usually discomfort is attributed to degenerative lumbar spine disease, spinal stenosis, vertebral compression fracture, or neoplasm. So a high index of clinical suspicion of SIF is required to avoid unnecessary diagnostic procedures. In most patients with SIF, bed rest, non-weight bearing ambulation, symptomatic treatment, and therapy for osteoporosis resulted in rapid improvement, and long-term follow-up of this fractures shows usually benign outcome. We are reporting a case of delayed detection of sacral fractures in osteoporotic woman.