Devoted to diagnostic and interventional spine imaging and therapeutics

Library

A Previously Unreported and Novel Approach to Sacroplasty 2006

Interventional Spine

Douglas K Smith, M.D., Non ASSR Member
Louis A Gilula, M.D., ASSR Member

Scientific Paper

Purpose

Percutaneous sacroplasty is a treatment for sacral insufficiency fractures. A technique described in the literature uses a perpendicular approach, often with multiple needle placements at various levels in the sacral ala to treat the fracture. The purpose of this presentation is to present a different approach to sacroplasty placing the needle along the plane of the fracture.

Methods & Materials

The patient is placed prone and the II is rotated 30 degrees opposite to the side being treated and with the beam parallel to the L5/S1 disc space to profile the sacral ala of interest. The bone cannula is inserted into the sacral ala at the midpoint between the inferior margin of the sacroiliac joint and the lateral margin of the S3 neural foramen. With lateral fluoroscopic control, the cannula is inserted into the intramedullary cavity of the sacral ala and directed toward the mid portion of the S1 vertebral body on the lateral projection. A similar approach is used to insert a bone cannula into the contralateral sacral ala. The cement is injected into each sacral ala as the cannula is slowly withdrawn to obtain a vertically oriented collection of cement in the sacrum aligned along the course of the sacral fractures. Care must be taken to avoid excessive advancement of the cannula through the cephalad cortex of the ala and the operator should observe the injection on the frontal plane to prevent cement extravasation into the neural foramen in those patients where the preprocedural CT shows the fracture extending through the neural foramen.

Results

This technique for injecting cement along the course of the sacral fractures has been successfully applied in over 22 patients (20 by the first author and 2 by the second author) for the past 4 years. It has been our experience that this technique is easier to perform than the technique using a short perpendicular axis approach and produces better cement distribution along the fracture line. The technique described in this presentation was derived from our experience treating over 2300 vertebral bodies.

Conclusion

A longitudinal approach to sacroplasty placing methylmethacrylate linearly along the sacral fracture line which we could not find previously reported is presented here. It is believed that this approach is easier and may provide more satisfactory distribution of methylmethacrylate along a sacral fracture line than that of the perpendicular approach to perform sacroplasty.

References

1. Garant M. Sacroplasty: A new Treatment for Sacral Insufficiency Fracture. U Vasc Interv Radiol 2002; 13:1265-67.
2. Pommersheim W, Huang-Hellinger F, Baker M, and Morris P. AJNR Am J Neuroradiol 2003:24;1003-07
3. Smith DK, Dix J. Percutaneous Sacroplasty: Long Axis Injection Technique. Accepted for Publication. Amer Journ of Roentgenology