J Korean Neurosurg Soc.  2020 Nov;63(6):747-756. 10.3340/jkns.2020.0014.

Percutaneous Sacroplasty : Effectiveness and Long-Term Outcome Predictors

• Lee J
• Lee E
• Lee JW
• Kang Y
• Ahn JM
• Kang HS

• KMID: 2508605
• DOI: http://doi.org/10.3340/jkns.2020.0014

Abstract

Objective
: To evaluate the effectiveness and long-term outcome predictors of percutaneous sacroplasty (PSP).
Methods
: This single-center study assessed 40 patients with sacral insufficiency fractures using the short-axis technique under C-arm flat-panel detector computed tomography (CT). Two radiologists reviewed the patients’ magnetic resonance and CT images to obtain imaging findings before PSP and determine technical success, respectively. The short-term outcomes were visual analog scale score changes and opioid usage reductions. Long-term outcomes were determined using telephone interviews and the North American Spine Society (NASS) patient-satisfaction index at least one year after PSP.
Results
: Technical success was achieved without any significant complications in 39 patients (97.5%). Telephone interviews were possible with 12 patients and failed in 10 patients; death was confirmed in 18 patients. Fifteen patients (50%) re-visited the hospital and received conservative treatment, including spinal injections. Nine patients reported positive satisfaction (NASS patient-satisfaction index 1 or 2), while the negative satisfaction group (NASS patient-satisfaction index 3 or 4, n=3) showed a higher incidence of compression fractures at the thoracolumbar spine level (66.7% vs. 22.2%) and previous spinal injection history (66.7% vs. 33.3%). The poor response group also showed higher incidences of facet joint arthrosis (100% vs. 55.6%), central canal stenosis (100% vs. 22.2%), neural foraminal stenosis (33.3% vs. 22.2%), scoliosis (100% vs. 33.3%), and sagittal malalignment (100% vs. 44.4%).
Conclusion
: PSP was effective for sacral insufficiency fractures and showed good long-term outcomes. Combined compression fractures in the thoracolumbar spine and degenerative lumbar pathologies could be possible poor outcome predictors.

Keyword

Sacrum; Fractures; Fluoroscopy; Vertebroplasty; Spinal stenosis

Figure

• 

  Fig. 1. Flow chart depicting the process of patient selection. NASS : North American Spine Society.

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  Fig. 2. A 72-year-old woman with sacral insufficiency fracture extension to both sacral ala, treated with the short-axis approach. A : Axial T2-weighted image shows fracture gaps with perilesional edema of the bilateral alae. We planned to place a needle at the fracture gap along the short axis of the sacrum parallel to the sacroiliac joint (arrows : the direction of the trocar needle, line : sacroiliac joint). B and C : A needle was inserted into the target site under fluoroscopy. D : C-arm flat-panel detector CT (C-arm CT) can check the precise needle position at a fracture site. The needle tip is shown within the sacrum with no violation of the anterior cortex of the sacrum. E and F : Each CT image demonstrates cement distribution. It shows near total cement filling at both SIF sites (arrows), without any cement leakage. CT : computed tomography.

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  Fig. 3. An 81-year-old woman complaining of left side radicular pain after the procedure. A-C : Axial image of pelvis computed tomography shows mild cement leakage (arrowhead) over the fractured anterior cortex led to irritation of the left L5 nerve root (arrows). D : The patient received transforaminal epidural steroid injection through the extraforaminal targeting approach at the L5/S1 level. Anteroposterior fluoroscopic image shows that injected contrast (arrowheads) flows along the medial margin of the pedicle.

Reference

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