SIR Foundation is collecting data for a sacroplasty registry that will showcase patient-reported outcomes and the response to treatment in regard to improvements in pain and patient function. Learn more at bit.ly/30Y8MUz.


The complication rate of sacroplasty is low; risks include cement extravasation and leakage associated with tissue damage, nerve and circulatory problems.9,10


The long-axis sacroplasty


technique cited in the AJR article on the SIR Connect post mitigates risk by improving cement distribution and risk of its leakage into surrounding structures.15


One limitation to all of


these articles is that there is a lack of randomized controlled studies to date regarding percutaneous sacroplasty for insufficiency fractures.10,14


The patient in this case was treated under CT-guidance for sacral insufficiency fractures with satisfactory postprocedure sacroplasty images. A few respondents on SIR Connect recommended waiting and seeing the patient in clinic 2 weeks post-op, which is a similar standard follow-up time per the clinical care pathway reviewed in Dr. Beall’s vertebroplasty article.6


Others commented regarding


repeat sacroplasty and bupivacaine joint nerve blocks with pre- and postprocedure NSAIDs.


This discussion may highlight a potential role for repeat sacroplasty in combination with other treatment modalities for refractory pain and patient education on underlying osteoporosis.6


Additional commentary from Douglas Beall, MD, FSIR Sacroplasty is a critically important treatment option for patients suffering from sacral insufficiency fractures and sacral metastatic disease and is highly effective at relieving pain and improving function as has been shown in numerous manuscripts. Sacroplasty is similar to vertebroplasty but is not the same, as it requires more cement and has different anatomy which requires that you treat these cases as a sacroplasty, not as a vertebroplasty of the sacrum.


The goal of sacroplasty is the civil engineering of the sacrum to be able withstand the compression and shear forces that are placed upon it while the individual is ambulating. Patients with sacral fractures tend to be older, more osteoporotic and more debilitated than the typical patient suffering from a painful vertebral compression fracture. This should remind us that we are physicians, not technicians, and the additional attention to the patient should include adequate follow-up, additional interventional pain procedures as is necessary, and treating the underlying disorder that gave rise to the fractures.


References


1. Radvany, et al. “Vertebroplasty and Kyphoplasty.” Handbook of Interventional Radiologic Procedures, by Krishna Kandarpa et al., Lippincott Williams & Wilkins, 2016, pp. 563–570.


2. Ortiz, A. Orlando, and Allan L. Brook. “Sacroplasty.” Techniques in Vascular and Interventional Radiology, vol. 12, no. 1, Mar. 2009, pp. 51–63. DOI. org (Crossref), doi:10.1053/j.tvir.2009.06.006.


3. Baerlocher, Mark O., et al. “Quality Improvement Guidelines for Percutaneous Vertebroplasty.” Journal of Vascular and Interventional Radiology, vol. 25, no. 2, Feb. 2014, pp. 165–70. DOI.org (Crossref), doi:10.1016/j.jvir.2013.09.004.


4. Maynard, A. Stanley, et al. Value of Bone Scan Imaging in Predicting Pain Relief from Percutaneous Vertebroplasty in Osteoporotic Vertebral Fractures. 2000, p. 6.


5. Health, Center for Devices and Radiological. “Polymethylmethacrylate (PMMA) Bone Cement—Class II Special Controls Guidance Document for Industry and FDA.” FDA, FDA, Feb. 2020. www.fda.gov, https://www.fda.gov/ medical-devices/guidance-documents-medical- devices-and-radiation-emitting-products/ polymethylmethacrylate-pmma-bone-cement- class-ii-special-controls-guidance-document- industry-and-fda.


6. Beall, Douglas P. “Feature: Pain Points. Improving the Treatment Pathway for Painful Vertebral Compression Fractures.” IR Quarterly, Summer 2019.


7. Simon, Jeremy I., et al. “Successful Repeat Sacroplasty in a Patient With a Recurrent Sacral Insufficiency Fracture: A Case Presentation.” PM&R, vol. 9, no. 11, 2017, pp. 1171–74. Wiley Online Library, doi:10.1016/j.pmrj.2017.04.002.


8. Frey, Michael E, et al. “Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations.” Pain Physician, p. 10.


9. Medtronic data on file: 31100918


10. Medtronic. Sacroplasty for Sacral Insufficiency Fractures. www.medtronic.com, https://www. medtronic.com/us-en/healthcare-professionals/ therapies-procedures/spinal-orthopaedic/ sacroplasty.html. Accessed 16 July 2020.


11. Frey, Michael E., et al. “Percutaneous Sacroplasty for Osteoporotic Sacral Insufficiency Fractures: A Prospective, Multicenter, Observational Pilot Study.” The Spine Journal, vol. 8, no. 2, Mar. 2008, pp. 367–73. DOI.org (Crossref), doi:10.1016/j. spinee.2007.05.011.


12. Gotis-Graham, I, et al. “Sacral Insufficiency Fractures in the Elderly.” The Journal of Bone and Joint Surgery. British Volume, 76-B, no. 6, 1994, pp. 882–886., doi: 10.1302/0301-620x. 76b6.7983111.


13. Lin, Julie, et al. “Sacral Insufficiency Fractures: A Report of Two Cases and a Review of the Literature.” Journal of Women’s Health & Gender-Based Medicine, vol. 10, no. 7, Sept. 2001, pp. 699–705. DOI.org (Crossref), doi:10.1089/15246090152563588.


14. Talmadge, Jennifer, et al. “Clinical Impact of Sacroplasty on Patient Mobility.” Journal of Vascular and Interventional Radiology, vol. 25, no. 6, June 2014, pp. 911–15. DOI.org (Crossref), doi:10.1016/j.jvir.2014.02.007.


15. Smith, Douglas K., and James E. Dix. “Percutaneous Sacroplasty: Long-Axis Injection Technique.” American Journal of Roentgenology, vol. 186, no. 5, May 2006, pp. 1252–55. DOI.org (Crossref), doi:10.2214/AJR.05.0823.


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