Sacroplasty

KEY FACTS

Terminology

• Percutaneous stabilization of sacral fracture via bone cement injection

Preprocedure

• Indications

  • Insufficiency fracture

  • Pathologic fracture

  • Posttraumatic fracture

• Laboratory data

  • Coagulation parameters

  • Infection/inflammation markers

• Imaging

  • Consistent with acute/subacute fracture

  • Look for retropulsion of bone fragments into sacral canal or neural foramina

  • Look for cortical breakthrough and epidural extension associated with tumors

Procedure

• Prone

  • AP fluoroscopy angled slightly to optimize visualization of entire sacrum

  • Direct lateral view is very important for optimal needle placement

  • Rotational flat-panel imaging may assist with confident needle placement prior to cement injection

• Advance needle through sacrum from dorsal S3 through upper S1 segment under intermittent fluoroscopic visualization

• Watch carefully for cement extravasation into sacroiliac joint, vasculature, &/or neural foramina

Outcomes

• Problems: Inability to diffuse polymethylmethacrylate throughout fracture/incomplete stabilization; cement extravasation into SI joints/sacral foramina/paraspinal veins

TERMINOLOGY