Anesth Pain Med.  2018 Jul;13(3):308-313. 10.17085/apm.2018.13.3.308.

Transiliac sacroplasty for Denis 3 fracture: Two cases report

• Chang W
• Lee S
• Kim H

• KMID: 2436040
• DOI: http://doi.org/10.17085/apm.2018.13.3.308

Abstract

We present two cases of percutaneous sacroplasty for sacral body fracture (Denis 3) and sacral alar fracture under multislice computed tomography (MSCT) guidance and discuss the clinical results and technical considerations. Sacroplasty is often recommended for the treatment of painful sacral insufficiency fractures, which destabilize the sacrum. However, sacroplasty for Denis zone 3 is rare because of the lack of validating controlled studies or unique technical considerations related to sacral anatomy. We performed sacroplasty for Denis zone 3 via the transiliac approach. Precise needle placement and polymethylmethacrylate cement injection were performed safely under the MSCT system. No complications occurred related to this procedure, such as iliac fracture, vascular leakage, or epidural leakage. MSCT-guided transiliac sacroplasty was a useful and effective solution in treating sacral body fracture.

Keyword

Buttock pain; Multislice computed tomography; Sacral body fracture; Sacroplasty; Transiliac approach

MeSH Terms

Fractures, Stress
Multidetector Computed Tomography
Needles
Polymethyl Methacrylate
Sacrum
Polymethyl Methacrylate

Figure

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  Fig. 1 (A) Fractures of the S1 sacral body (white arrow) and both alae. (B) The skin entry points for the alar fractures are identified using a MSCT scanner. MSCT: multislice computed tomography.

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  Fig. 2 A PVP needle is introduced via the transiliac approach under MSCT guidance. PVP: percutaneous vertebroplasty, MSCT: multislice computed tomography.

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  Fig. 3 Bone cement is injected to the sacral body under serial MSCT monitoring. MSCT: multislice computed tomography.

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  Fig. 4 (A) Bone cement is injected via each cannula. (B) A radiograph showing good distribution of cement over the area of the sacral fracture.

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  Fig. 5 (A) An MRI scan demonstrating sacral S1 and S2 body fractures (white arrows). (B, C) The entry point is established by tilting the MSCT scan gantry to find a safe pathway that does not cross the anatomical landmarks. MRI: magnetic resonance imaging, MSCT: multislice computed tomography.

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  Fig. 6 PMMA cement is introduced at the S1 sacral body. PMMA: polymethylmethacrylate.

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  Fig. 7 (A, B) PMMA cement is introduced at the S2 sacral body. (C) A radiograph showing optimal filling of PMMA at the S1 and S2 sacral bodies. PMMA: polymethylmethacrylate.

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