Navigated Transsacral Screw Fixation for the Treatment of Bilateral Sacral Insufficiency Fractures

AbstractAn increasing incidence of sacral insufficiency fractures in geriatric patients has been documented, representing a major challenge to our healthcare system. Determining the accurate diagnosis requires the use of sectional imaging, including computed tomography and magnetic resonance imaging. Initially, non-surgical treatment is indicated for the majority of patients. If non-surgical treatment fails, several minimally invasive therapeutic strategies can be used, which have shown promising results in small case series. These approaches are sacroplasty, percutaneous iliosacral screw fixation (S1 with or without S2), trans-sacral screw fixation or implantation of a trans-sacral bar, transiliac internal fixator stabilisation, and spinopelvic stabilisation. These surgical strategies and their indications are reported in detail. Generally, treatment-related decision making depends on the clinical presentation, fracture morphology, and attending surgeonʼs experience.

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Percutaneous screw fixation for sacral insufficiency fractures

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.89b12.19058 ◽

2007 ◽

Vol 89-B (12) ◽

pp. 1650-1653 ◽

Cited By ~ 29

Author(s):

E. Tsiridis ◽

N. Upadhyay ◽

Z. Gamie ◽

P. V. Giannoudis

Keyword(s):

Screw Fixation ◽

Insufficiency Fractures ◽

Percutaneous Screw Fixation ◽

Sacral Insufficiency Fractures

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Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

Neurosurgical FOCUS ◽

10.3171/2014.3.focus1428 ◽

2014 ◽

Vol 36 (5) ◽

pp. E10 ◽

Cited By ~ 9

Author(s):

Rajiv Saigal ◽

Darryl Lau ◽

Rishi Wadhwa ◽

Hai Le ◽

Morsi Khashan ◽

...

Keyword(s):

Postoperative Infection ◽

Screw Fixation ◽

Insufficiency Fractures ◽

Single Institution ◽

Spinopelvic Fixation ◽

Iliac Screws ◽

Iliac Screw ◽

Sacral Insufficiency Fractures ◽

The Mean

Object Long-segment spinal instrumentation ending at the sacrum places substantial biomechanical stress on sacral screws. Iliac (pelvic) screws relieve some of this stress by supplementing the caudal fixation. It remains an open question whether there is any clinically significant difference in sacropelvic fixation with bilateral versus unilateral iliac screws. The primary purpose of this study was to compare clinical and radiographic complications in the use of bilateral versus unilateral iliac screw fixation. Methods The authors retrospectively reviewed 102 consecutive spinal fixation cases that extended to the pelvis at a single institution (University of California, San Francisco) in the period from 2005 to 2012 performed by the senior authors. Charts were reviewed for the following complications: reoperation, L5–S1 pseudarthrosis, sacral insufficiency fracture, hardware prominence, iliac screw loosening, and infection. The t-test, Pearson chi-square test, and Fisher exact test were used to determine statistical significance. Results The mean follow-up was 31 months. Thirty cases were excluded: 12 for inadequate follow-up, 15 for lack of L5–S1 interbody fusion, and 3 for preoperative osteomyelitis. The mean age among the 72 remaining cases was 62 years (range 39–79 years). Forty-six patients underwent unilateral and 26 bilateral iliac screw fixation. Forty-one percent (n = 19) of the unilateral cases and 50% (n = 13) of the bilateral cases were treated with reoperation (p = 0.48). In addition, 13% (n = 6) of the unilateral and 19% (n = 5) of the bilateral cases developed L5–S1 pseudarthrosis (p = 0.51). There were no sacral insufficiency fractures. Thirteen percent (n = 6) of the unilateral and 7.7% (n = 2) of the bilateral cases developed postoperative infection (p = 0.70). Conclusions In a retrospective single-institution study, single versus dual pelvic screws led to comparable rates of reoperation, iliac screw removal, postoperative infection, pseudarthrosis, and sacral insufficiency fractures. For spinopelvic fixation, placing bilateral (vs unilateral) pelvic screws produced no added clinical benefit in most cases.

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Percutaneous Sacroplasty for Sacral Insufficiency Fractures: Case Series and Review of Presentation, Diagnosis, and Treatment

American Journal of Interventional Radiology ◽

10.25259/ajir-55-2018 ◽

2019 ◽

Vol 3 ◽

pp. 4

Author(s):

Andrew C. Clark ◽

Devang Butani

Keyword(s):

Low Back Pain ◽

Elderly Population ◽

Case Series ◽

The Elderly ◽

Treatment Method ◽

Open Reduction Internal Fixation ◽

Low Back ◽

Insufficiency Fractures ◽

Invasive Treatment ◽

Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

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