Devoted to diagnostic and interventional spine imaging and therapeutics



Interventional Spine

Luigi, Manfre, MD



Painful sacral insufficiency or tumoral fractures are clearly detected on MRI and bone scanning. Moreover, coccygeal sublussation after trauma can be responsible for unsustainable pain when the patient is seated, and only surgical removing of the coccyx has been proposed till now. The purpose of our investigation was to obtain sacral and coccigeal vertebroplasty using CT-guided percutaneous fractionated injection of polymethylmethacrylate.

Methods & Materials

Among 1244 patients undergone Vertebroplasty procedure, 21 cases with osteoporotic or neoplastic sacral involvement were selected. All the patients referred severe local pain and motion disability. Pain intensity was scored on a VAS scale ranging from 0 (no pain) to 10 (unsustainable pain). Motion disability was graded using a 5-points scale. In patients with osteoporotic fractures, bilateral paraspinal approach through the sacral body-to-wing lines was used. In sacral malignancy, trans-alar route and/or trans-foraminal route were adopted. Multiple 2-3cc PMMA microinjections were performed under CT-guide, to remodel the original sacral shape. In the 7 patients with coccygeal luxation, the coccyx was fused to S5 using a single shot of PMMA and transacral-coccigeal route.


All the patients were painless or referred significant pain reduction after 4 weeks. Complete sacral remodel was achieved in all the patients, without foraminal or extra-sacral leakage nor complications. In patients with coccygeal sublussation, the pain was resolved immediately after the treatment, the patients being painless in seated position.


CT guided fractionated PMMA injections allows efficient sacral and coccyx remodeling preventing PMMA foraminal leakage, resolving the pain of patients, allowing the patient to mantain the seated position with no pain.