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Percutaneous Sacroplasty for the Treatment of Sacral Insufficiency Fractures

Carina L. Butler1, Curtis A. Given, II1, Steven J. Michel1 and Phillip A. Tibbs2

1 Department of Diagnostic Radiology, University of Kentucky Chandler Medical Center, Rm. HX-311C, 800 Rose St., Lexington, KY 40536.
2 Department of Neurosurgery, University of Kentucky Chandler Medical Center Lexington, KY.



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  		Fig. 1A. —71-year-old woman with history of cervical and colon cancer and bedridden with pain and sacral insufficiency fracture secondary to radiation necrosis (biopsy before treatment negative for tumor). Posterior delayed image of pelvis from technetium-99m methylene diphosphonate bone scan shows increased tracer uptake within sacrum, giving characteristic H shape seen with bilateral sacral insufficiency fractures. Tracer uptake localizes greater toward right side.

 


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  		Fig. 1B. —71-year-old woman with history of cervical and colon cancer and bedridden with pain and sacral insufficiency fracture secondary to radiation necrosis (biopsy before treatment negative for tumor). Axial CT fluoroscopy image with patient in prone position shows proper placement of trocar needle (arrow) within right sacrum, avoiding sacroiliac joint and sacral foramina (arrowhead).

 


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  		Fig. 1C. —71-year-old woman with history of cervical and colon cancer and bedridden with pain and sacral insufficiency fracture secondary to radiation necrosis (biopsy before treatment negative for tumor). Posteroanterior radiograph of sacrum after injection of polymethylmethacrylate (PMMA) solution. PMMA fills bilateral sacrum in expected trabecular pattern, with more PMMA distributed toward right side.

 


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  		Fig. 1D. —71-year-old woman with history of cervical and colon cancer and bedridden with pain and sacral insufficiency fracture secondary to radiation necrosis (biopsy before treatment negative for tumor). Axial CT image after sacroplasty shows PMMA filling bilateral marrow spaces of sacrum.

 


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  		Fig. 1E. —71-year-old woman with history of cervical and colon cancer and bedridden with pain and sacral insufficiency fracture secondary to radiation necrosis (biopsy before treatment negative for tumor). Anterior maximum-intensity projection-reformatted CT image after sacroplasty shows PMMA filling bilateral marrow spaces of sacrum.

 


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  		Fig. 2A. —76-year-old woman with history of osteoporosis and severe pelvic pain with sacral insufficiency fracture. Posterior delayed image of pelvis from technetium-99m methylene diphosphonate bone scan shows increased tracer uptake within sacrum and characteristic H sign of bilateral sacral insufficiency fractures.

 


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  		Fig. 2B. —76-year-old woman with history of osteoporosis and severe pelvic pain with sacral insufficiency fracture. Axial T1-weighted MR image (TR/TE, 550/15) shows edema within bilateral sacrum (arrows) consistent with sacral insufficiency fractures.

 


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  		Fig. 2C. —76-year-old woman with history of osteoporosis and severe pelvic pain with sacral insufficiency fracture. Axial CT fluoroscopy image with patient in prone position shows proper placement of trocar needle (arrow) within right sacrum. The patient had complicating chronic right iliac wing fracture (arrowhead).

 


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  		Fig. 2D. —76-year-old woman with history of osteoporosis and severe pelvic pain with sacral insufficiency fracture. Posteroanterior radiograph of sacrum after placement of four 13-gauge trocar needles within sacrum.

 


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  		Fig. 2E. —76-year-old woman with history of osteoporosis and severe pelvic pain with sacral insufficiency fracture. Posteroanterior radiograph of sacrum after injection of polymethylmethacrylate (PMMA) solution shows PMMA filling sacrum in expected trabecular pattern.

 


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  		Fig. 2F. —76-year-old woman with history of osteoporosis and severe pelvic pain with sacral insufficiency fracture. Axial CT image (through superior sacrum) after sacroplasty illustrates PMMA (arrows) filling marrow space of sacrum.

 

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