Background: The treatment of sacral fractures has evolved since its first description in 1982.
Several techniques for sacral augmentation have been developed since 2001, and the rate of
improvement is rapid with over 50% reduction in pain achieved prior to post-procedure discharge
of the patient. Pain reduction occurs primarily within the first 3 months and is sustained at 12
months; however, the long-term outcomes have not previously been studied.
Objectives: We aim to evaluate the long-term efficacy of sacroplasty versus non-surgical
management (NSM) in treating sacral insufficiency fractures (SIFs), including the effect on pain
relief, opioid and other analgesic use, patient satisfaction, and complication rates. Additionally, we
aim to review the most current sacroplasty literature.
Study Design: A 10-year prospective, observational cohort study of patients with SIFs treated
with sacral augmentation.
Setting: A single-center interventional pain management private practice.
Methods: Two-hundred and forty-four patients with SIFs were treated with sacroplasty (210
patients) or NSM (34 patients) beginning in January 2004 and then followed for 10 years. The
patients’ gender, age, pre-procedure pain duration, analgesic use, pain level, and satisfaction were
recorded at baseline and at post-procedure follow-up intervals of 2, 4, 12, 24, 52 weeks, and
2 years. The experimental group was then contacted at 10 years. Post-procedure complications
before discharge and at each follow-up were also evaluated.
Results: Both NSM and sacroplasty resulted in statistically significant drops in visual analog scale
(VAS) scores from pre-treatment to 2-year follow-up (P < 0.001). When measured from followup to follow-up, the NSM group’s only significant decrease in the mean VAS score was between
pre-treatment and 2 weeks (P = 0.002). The experimental group had significant decreases over
the periods pre-op through post-op (P < 0.001), post-op through 2 weeks (P < 0.001), 12 weeks
through 24 weeks (P = 0.014), and 24 weeks through one year (P = 0.002). The experimental
cohort experienced statistically significant drops in the mean VAS scores between follow-ups for a
longer period of time. Opioid and non-opioid analgesic use was markedly decreased preoperatively
to postoperatively and was sustained at the 10-year follow-up.
Limitations: Patients were placed into the control group, NSM, if they did not meet inclusion
criteria for sacroplasty. However, the baseline characteristics of the sacroplasty versus NSM group
were not statistically different. Additionally, the control group was only followed through 2 years
and was not contacted at the 10-year follow-up.
Conclusions: Our results and those reported in previous studies establish that sacroplasty allows
for decreased use of medications and results in pain relief, greater patient mobility, and improved
patient satisfaction. In addition to the published body of literature, our results show strong evidence
in support of sacroplasty as a safe and efficacious treatment of SIFs.
Key words: Sacroplasty, sacral fracture, fracture, osteoporosis, insufficiency, radiology
Influence of Allopurinol on Evoked Cortical Afterdischarges During Early Ontogenesis
