J Korean Neurosurg Soc.  2017 Jan;60(1):60-66. 10.3340/jkns.2016.0505.010.

Effects of Percutaneous Sacroplasty on Pain and Mobility in Sacral Insufficiency Fracture

• Choi KC
• Shin SH
• Lee DC
• Shim HK
• Park CK

• KMID: 2365588
• DOI: http://doi.org/10.3340/jkns.2016.0505.010

Abstract

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.

Keyword

Percutaneous sacroplasty; Vertebroplasty; Sacral insufficiency fracture; Activities of daily living; Mobility; Quality of life

MeSH Terms

Activities of Daily Living
Aged
Bandages
Baths
Data Collection
Fractures, Stress*
Housekeeping
Humans
Immobilization
Low Back Pain
Male
Prospective Studies
Quality of Life
Vertebroplasty

Figure

• 

  Fig. 1 Intraoperative radiography (A) showing the sacral body margin (black line) and ala margin (white line). The entry point is the infero-lateral margin of the S1 pedicle (black circle) and the needle is inserted parallel to the S1 upper endplate (white dotted line). Contralateral oblique radiography (B) showing ipsilateral SI joint space (white line). Antero-posterior (C) and lateral (D) radiographies showing polymethylmethacrylate cement in the sacral ala with no extravasation. SI: sacroiliac.

• 

  Fig. 2 Changes of VAS scores (A) and ODI scores (B) after percutaneous sacroplasty. VAS: visual analogue scale, ODI: Oswestry disability index.

• 

  Fig. 3 ADLs including six items improved after sacroplasty, 3 months later. ADLs: activities of daily living.

• 

  Fig. 4 A 74-years old woman presented with severe left buttock and leg radiating pain as the L5 dermatome after slippage. A: Coronal STIR MR image showing bone marrow edema in the left sacrum. B: A CT scan showing cortical disruption of the left sacral ala. C: Intraoperative radiography showing PMMA injection in the left sacral ala. D: After the sacroplasty, the pain improved and CT scan showed PMMA in the sacral ala with minimal extraosseous minimal leakage. STIR: short tau inversion recovery, MR: magnetic resonance, CT: computed tomography, PMMA: polymethylmethacrylate.

• 

  Fig. 5 Long axis injection technique. The entry point is between the inferior margin of the sacroiliac joint and the lateral margin of the S3 or S4 dorsal foramen. The needle trajectory (white line) advances to the mid-portion of the S1 body.

Reference

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