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Percutaneous Sacroplasty: Long-Axis Injection Technique

Douglas K. Smith1 and James E. Dix1

1 Both authors: South Texas Radiology Group, 9150 Hueber Rd., Ste. 195, San Antonio, TX 78230.


Figure 1
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  		Fig. 1A —Long-axis injection technique for percutaneous sacroplasty. Anteroposterior radiograph of pelvis shows lateral margin of sacral ala (white line) and posterior margin of iliac crest (black arrowheads). Lateral margins of S1 and S2 arcuate lines are indicated by white arrowheads.

 

Figure 2
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  		Fig. 1B —Long-axis injection technique for percutaneous sacroplasty. Coronal oblique reconstruction of CT scan of normal sacrum from 25° right posterior oblique projection directed along anteroposterior axis of left sacroiliac joint (between large arrows). Posterosuperior iliac spine (PSIS) covers mid portion of sacroiliac joint in this projection. Lateral margins of left dorsal sacral foramina (white squares) may be difficult to see using fluoroscopy but can be approximated using a line drawn between center of S5 dorsal sacral foramen and geometric center of left L5-S1 facet joint (vertical line between asterisks). Needle insertion site into sacrum is at midpoint between inferior margin of sacroiliac joint and lateral margin of nearest dorsal foramen (usually S3 or S4). Horizontal arrows outline lateral margins of right L5-S1 facet joint and lateral margins of dorsal sacral neuroforamina, forming a smooth curve.

 

Figure 3
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  		Fig. 1C —Long-axis injection technique for percutaneous sacroplasty. Coronal T1-weighted MR image of 84-year-old woman shows typical location and orientation of bilateral sacral insufficiency fractures (arrows).

 

Figure 4
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  		Fig. 1D —Long-axis injection technique for percutaneous sacroplasty. Same patient as C. Three-dimensional reconstruction of sacrum with sagittal cutaway through plane of sacral alar fracture shows anterior cortex of ala (arrows) located at mid portion of S1 sacral body (B). Location of intramedullary needle tract is identified by white line.

 

Figure 5
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  		Fig. 2A —85-year-old woman with bilateral sacral insufficiency fractures. Frontal radiograph shows bilateral needle placement for treatment of bilateral sacral insufficiency fractures.

 

Figure 6
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  		Fig. 2B —85-year-old woman with bilateral sacral insufficiency fractures. Frontal radiograph shows vertically oriented distribution of cement along fractures of sacral ala.

 

Figure 7
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  		Fig. 2C —85-year-old woman with bilateral sacral insufficiency fractures. Lateral fluoroscopic image shows needle position inferior to midpoint of S1 vertebral body (B). Small arrows outline anterior border of sacral ala. Large arrow identifies associated transverse fracture line.

 

Figure 8
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  		Fig. 2D —85-year-old woman with bilateral sacral insufficiency fractures. Lateral fluoroscopic image after cement injection shows cement extending along course of sacral ala but not cephalad to superior margin of sacral alae outlined by arrows. B indicates S1 vertebral body.

 

Figure 9
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  		Fig. 2E —85-year-old woman with bilateral sacral insufficiency fractures. Axial CT image shows cement extrusion through superior cortex of right sacral ala (arrow) resulting from cortical penetration of superior cortex.

 

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