scholarly journals Balloon kyphoplasty for treatment of sacral insufficiency fractures

2005 ◽  
Vol 18 (3) ◽  
pp. 1-5 ◽  
Author(s):  
H. Gordon Deen ◽  
Eric W. Nottmeier
Keyword(s):  
Image Guidance ◽  
Elderly Women ◽  
Insufficiency Fracture ◽  
Balloon Kyphoplasty ◽  
Fracture Site ◽  
Intractable Pain ◽  
Insufficiency Fractures ◽  
Sacral Insufficiency Fracture ◽  
Analgesic Medication ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fracture is a painful injury, for which no effective treatment currently exists. The objective of this study was to report on the clinical outcomes and technical aspects of balloon kyphoplasty, which was used in three patients with this injury. Three elderly women with intractable pain from sacral insufficiency fractures were treated with polymethyl methacrylate (PMMA) injections into the sacrum by using a modified balloon kyphoplasty procedure. The visual analog scale pain score improved by four points in each case. Functional status was improved and analgesic medication requirements were decreased in all three patients. There were no complications associated with the procedure. Because of the unique anatomy of the sacrum, it was difficult to monitor instrument placement and PMMA injection by using conventional fluoroscopy. BrainLAB image guidance was used in one case, and was helpful in guiding instrument placement and assuring accurate PMMA deposition at the fracture site. Balloon kyphoplasty may be a treatment alternative in selected patients with sacral insufficiency fractures. BrainLAB image guidance may offer some advantages over conventional fluoroscopy with regard to the monitoring of instrument placement and PMMA injection.

scholarly journals Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm

2020 ◽  
Vol 33 (2) ◽  
pp. 225-236 ◽  
Author(s):  
Thomas J. Buell ◽  
Ulas Yener ◽  
Tony R. Wang ◽  
Avery L. Buchholz ◽  
Chun-Po Yen ◽  
...  
Keyword(s):  
Insufficiency Fracture ◽  
Sacral Fracture ◽  
Leg Pain ◽  
Insufficiency Fractures ◽  
Lower Extremity Weakness ◽  
Sacral Insufficiency Fracture ◽  
Lumbopelvic Fixation ◽  
Iliac Screws ◽  
Sacral Insufficiency Fractures

OBJECTIVESacral insufficiency fracture after lumbosacral (LS) arthrodesis is an uncommon complication. The objective of this study was to report the authors’ operative experience managing this complication, review pertinent literature, and propose a treatment algorithm.METHODSThe authors analyzed consecutive adult patients treated at their institution from 2009 to 2018. Patients who underwent surgery for sacral insufficiency fractures after posterior instrumented LS arthrodesis were included. PubMed was queried to identify relevant articles detailing management of this complication.RESULTSNine patients with a minimum 6-month follow-up were included (mean age 73 ± 6 years, BMI 30 ± 6 kg/m2, 56% women, mean follow-up 35 months, range 8–96 months). Six patients had osteopenia/osteoporosis (mean dual energy x-ray absorptiometry hip T-score −1.6 ± 0.5) and 3 received treatment. Index LS arthrodesis was performed for spinal stenosis (n = 6), proximal junctional kyphosis (n = 2), degenerative scoliosis (n = 1), and high-grade spondylolisthesis (n = 1). Presenting symptoms of back/leg pain (n = 9) or lower extremity weakness (n = 3) most commonly occurred within 4 weeks of index LS arthrodesis, which prompted CT for fracture diagnosis at a mean of 6 weeks postoperatively. All sacral fractures were adjacent or involved S1 screws and traversed the spinal canal (Denis zone III). H-, U-, or T-type sacral fracture morphology was identified in 7 patients. Most fractures (n = 8) were Roy-Camille type II (anterior displacement with kyphosis). All patients underwent lumbopelvic fixation via a posterior-only approach; mean operative duration and blood loss were 3.3 hours and 850 ml, respectively. Bilateral dual iliac screws were utilized in 8 patients. Back/leg pain and weakness improved postoperatively. Mean sacral fracture anterolisthesis and kyphotic angulation improved (from 8 mm/11° to 4 mm/5°, respectively) and all fractures were healed on radiographic follow-up (mean duration 29 months, range 8–90 months). Two patients underwent revision for rod fractures at 1 and 2 years postoperatively. A literature review found 17 studies describing 87 cases; potential risk factors were osteoporosis, longer fusions, high pelvic incidence (PI), and postoperative PI-to–lumbar lordosis (LL) mismatch.CONCLUSIONSA high index of suspicion is needed to diagnose sacral insufficiency fracture after LS arthrodesis. A trial of conservative management is reasonable for select patients; potential surgical indications include refractory pain, neurological deficit, fracture nonunion with anterolisthesis or kyphotic angulation, L5–S1 pseudarthrosis, and spinopelvic malalignment. Lumbopelvic fixation with iliac screws may be effective salvage treatment to allow fracture healing and symptom improvement. High-risk patients may benefit from prophylactic lumbopelvic fixation at the time of index LS arthrodesis.

scholarly journals Effect of Complex Korean Medicine Treatment on Sacral Insufficiency Fracture: A Case Report

2020 ◽  
Vol 37 (3) ◽  
pp. 187-192
Author(s):  
Ga Hyeon Jung ◽  
Hyun Lee ◽  
Hwa Yeon Ryu ◽  
Jae Hui Kang
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Insufficiency Fracture ◽  
Sacral Insufficiency Fracture ◽  
Korean Medicine ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
History Of ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIF) are a common, but often underdiagnosed source of lower back pain without apparent trauma. This report presents the clinical outcome of a 75-year-old female with SIF, and an underlying medical history of osteoporosis and rheumatoid arthritis. She was treated non-operatively, in-hospital, with Korean medicine. Patient progress was assessed using the numerical rating scale and selfreported symptoms. Post-treatment, the numerical rating scale score for pain in her hip decreased from 7 to 2. At admission, the patient was unable to sit, and could only walk 3 m with assistance. At discharge, she could sit for longer than 1 hour and walk further than 200 m unassisted. On the follow-up visit, the patient was asymptomatic, and x-ray scans showed ossification of the sacral and pubic fractures. These results suggest that, Korean medicine can effectively reduce pain and aid rehabilitation in patients with SIF, without the need for surgery.

Tarlov Cyst Causing Sacral Insufficiency Fracture

2017 ◽  
Vol 13 (3) ◽  
pp. E4-E7 ◽  
Author(s):  
Ross C. Puffer ◽  
Marcus J. Gates ◽  
William Copeland ◽  
William E. Krauss ◽  
Jeremy Fogelson
Keyword(s):  
Bone Erosion ◽  
Insufficiency Fracture ◽  
Bowel Dysfunction ◽  
Insufficiency Fractures ◽  
Large Area ◽  
Nerve Roots ◽  
Posterior Aspect ◽  
Sacral Insufficiency Fracture ◽  
Tarlov Cyst ◽  
Tarlov Cysts

Abstract BACKGROUND AND IMPORTANCE: Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. CLINICAL PRESENTATION: The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg. There was no recent history of spine or pelvic trauma. These symptoms prompted her initial emergency department evaluation, and imaging demonstrated a large Tarlov cyst with an associated sacral insufficiency fracture. She was noted to have a normal neurological examination notable only for an antalgic gait. She was taken to surgery via a posterior approach and the cyst was identified eccentric to the left. The cyst was fenestrated and the nerve roots identified. Given her large area of bone erosion and insufficiency fractures, fixation of the sacroiliac joints was deemed necessary. Fusion was extended to the L5 vertebral body to buttress the fixation. She tolerated the procedure well and was discharged from the hospital on postoperative day 3. CONCLUSION: Tarlov cysts of the sacrum can lead to significant bone erosion and subsequent insufficiency fractures, requiring fenestration and in some cases, complex sacropelvic fixation.

scholarly journals Sacral Vertebral Augmentation: Confirmation of Fluoroscopic Landmarks by Open Dissection

2008 ◽  
Vol 1;11 (1;1) ◽  
pp. 57-65
Author(s):  
Andres Betts
Keyword(s):  
Balloon Kyphoplasty ◽  
Vertebral Augmentation ◽  
Insufficiency Fractures ◽  
Cadaveric Specimen ◽  
Spine Pain ◽  
Fluoroscopic Imaging ◽  
Sacral Insufficiency Fractures ◽  
Controlled Deposition ◽  
Pmma Cement ◽  
Cannula Placement

Sacral insufficiency fractures are a more commonly recognized cause of spine pain among osteoporotic patients, and are now treatable by sacroplasty using percutaneous instillation of PMMA cement. Sacroplasty may be performed using only fluoroscopic landmarks; however, the bony anatomy of the sacrum is complex and the cement deposition based on these landmarks has not been specifically confirmed. In this report we determined the precise fluoroscopic landmarks for cannula placement in a specially prepared excised sacral cadaveric specimen with metal surface markers. The cannulas were placed using the usual dorsal approach, and where the tip was visually seen to breach the cortical surface, fluoroscopic images were obtained and the boundaries of the sacrum were carefully determined. A fluoroscopic cortical “breach” area emerged where a cannula tip would likely be outside the cortical boundaries of the sacrum. With simple sacral vertebroplasty there is no direct control of cement deposition after the PMMA leaves the tip of the cannula. The use of vertebral augmentation devices may be of use to help control cement delivery in performing sacroplasty. We evaluated 2 such devices in cadaver specimens to determine their suitability in performing a sacral vertebral augmentation. Using these same landmarks, a sacral balloon Kyphoplasty was performed and the cadaveric specimen was subsequently bivalved to visually confirm the deposition of cement. On direct inspection the PMMA cement was found to be confined within the sacral cortical boundaries and there was no extravasation near or into the sacral foramen. Based on these fluoroscopic landmarks, the Arcuplasty device was tested in an intact cadaver to determine the optimal cannula placement and locations for creating osteotomies within the sacral trabecular bone prior to PMMA cement deposition. The cement deposition was observed to remain closely confined to the areas where the osteotomies were performed. In the balloon Kyphoplasty specimen the cement deposition was visually confirmed to be confined within the cortical boundaries by open dissection, and both devices have been found successful in creating a more controlled deposition of PMMA cement for performing sacral vertebral augmentation under fluoroscopic imaging. Key words: Sacroplasty, vertebroplasty vertebral augmentation, kyphoplasty, sacral insufficiency fractures, osteoporosis.

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

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.

Insufficiency Fractures vs. Low-Energy Pelvic Ring Fractures – Epidemiological, Diagnostic and Therapeutic Characteristics of Fragility Fractures of the Pelvic Ring

2021 ◽  
Author(s):  
Manuel Sterneder ◽  
Patricia Lang ◽  
Hans-Joachim Riesner ◽  
Carsten Hackenbroch ◽  
Benedikt Friemert ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Diagnostic Testing ◽  
Insufficiency Fracture ◽  
Fragility Fractures ◽  
Relative Increase ◽  
Trauma Centre ◽  
Low Energy ◽  
Insufficiency Fractures ◽  
Type Iv ◽  
Pelvic Ring Fractures

Abstract Background Fragility fractures of the pelvis (FFP) encompass two fracture entities: fracture after low-energy trauma and insufficiency fracture without trauma. It is unclear whether the two subgroups differ in terms of diagnosis and therapy. The aim of this retrospective study was to evaluate insufficiency fractures with regard to defined parameters and to compare specific parameters with the fractures after low-energy trauma. Patients and Methods In the period from 2008 to 2017, 203 patients with FFP were recorded at our clinic (Level 1 Trauma Centre DGU, SAV approval). Of these, 25 had an insufficiency fracture and 178 had a pelvic ring fracture after low-energy trauma. Epidemiological, diagnostic and therapeutic parameters were examined. Results There was a relative increase in the insufficiency fracture within the FFP (2008 – 2009: 5.0% vs. 2015 – 2017: 17.8%). In these patients, osteoporosis tended to be more pronounced than in patients after low-energy trauma (t-value: − 3.66 vs. − 3.13). The diagnosis of insufficiency fractures showed increased use of MRI and DECT (60.9% vs. 26.0%) and a high proportion of type IV fractures after FFP (40.0% vs. 7.9%). In terms of therapy, surgical treatment of the insufficiency fracture was sought more often (68,2% vs. 52,1%), with a tendency towards increased use of combined osteosynthesis procedures (14.3% vs. 7.6%). Conclusion We were able to show that as the number of cases increases, the insufficiency fracture becomes more important within FFP. If these patients tend to have more pronounced osteoporosis, particular attention should be paid to the diagnosis and adequate therapy of the osteoporosis, especially in the case of an insufficiency fracture. In addition to the increased diagnostic testing using MRI and DECT to detect oedema and the increased surgical therapy for this type of fracture, it is also noteworthy that the insufficiency fracture can cause higher-grade fractures after FFP.

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