| Efficacy of Percutaneous Sacroplasty for the Treatment of Painful
Osteoporotic Sacral Insufficiency Fracture in Elderly Patients |
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Austin Hyuk Kwon , Han Woong Kim , Jae Wook Song , Min Cheol Lee, Yun Sung Kim , Sang Kyu Kim , In Hwan Kim |
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Department of Neurosurgery, Gwang-ju Sae-Woori Spine Hospital, Gwang-ju, Korea |
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| Abstract |
Background
The purpose of this study is to illustrate the effectiveness and utility of percutaneous sacroplasty in the treatment of elderly
osteoporotic sacral insufficiency fractures and the technical considerations in performing the procedures.
Materials
and Methods: This study was performed from March 2007 to March 2009. Total 10 patients of sacral insufficiency fractures
resulted from osteoporosis. Seven patients had percutaneous sacroplasty performed. All patients had MRI, bone mineral densitometry
(BMD) and CT before the procedures. Patients pre-procedure Visual Analog Scale (VAS), and the ability to perform activities of daily living
(ADLs) and post-procedure follow up 1, 14, 30, and 90 days were assessed.
Results
Sacroplasty was performed in seven patients who had no improvement after conservative management for means of 14
days. Seven females with mean ages of 77 years (range, 73-83)) were treated. Their mean bone mineral densitometry t scores were
-5.13. All patients were available at follow-up interval. One patient was administered to university hospital for unrelated pneumonia
just after 2 week follow up. Technical success of adequate distribution of cement throughout the marrow space was achieved in most
of the cases. All patients reported at least mild relief of pain before the discharge, and six reported significant or complete relief of pain
or symptom at least two weeks after the procedure. The mean VAS score at the baseline was 8.4 before discharged, and 2 at two
weeks. Before the procedure, all patients were able to perform ADLs with a pain score of 4 (ADLs with severe pain). At follow up only 1
patient had scores of 3 (ADLs with moderate pain). The sacroplasty was effective in reducing or eliminating pain in these osteoporotic
compression patients. No patient had worsening of symptom after procedures, and none of the neural foramina was violated by the
PMMA leakages. No severe complication was encountered during of immediate follow-up periods. Minimal venous intravasation of
PMMA and extension to upper discal space was noted in one case each; however, it was clinically insignificant.
Conclusion
Sacroplasty is relatively safe and effective treatment modality for osteoporotic SIF under CT or fluoroscopic guidance. It is an
excellent alternative to conventional medical therapy alone. We have treated successfully with patients with intractable pain due to osteoporosis.
It requires keen attention for proper selection of the cases and avoidance of cement leakage into neural foramen to avoid
complication. |
| Key Words:
OsteoporosisㆍSacral insufficiency fracturesㆍSacroplasty |
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