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Sacroplasty for Tumor-Associated Sacral Insufficiency Fractures 2014

Category Interventional Nelson Moussazadeh
Patrick Boland
Ilya Laufer
Mark Bilsky
Eric Lis, MD
Purpose Tumor-associated sacral insufficiency fractures (SIF) present a significant clinical challenge. As survivability increases for many malignancies, sacral fractures associated with metastases, sacral or extended pelvic radiation, and paraneoplastic osteoporosis are increasingly common and yet remain difficult to treat in the setting of the unacceptable morbidity of open sacral surgery. While sacroplasty has been well-described in the degenerative literature and for osteolytic metastases, we herein describe our prospective experience with sacroplasty for tumor-associated, including the largest series to date of radiation-induced SIF. Materials & Methods Twenty-five patients aged 32-84 with intractable sacral or referable radicular pain and imaging evidence of SIF were included. Six suffered from baseline urinary/fecal incontinence. Thirty-one percutaneous sacral cement augmentation procedures were performed with a median 5.8cc of PMMA or Cortoss under fluoroscopic guidance and with concurrent biopsy acquisition. Fourteen patients had undergone previous sacral radiation and were found to have no viable tumor; 4 patients had active lytic lesions; 3 patients had undergone pelvic radiation without biopsy evidence of local disease, and 2 patients had other potential oncologic-related etiologies for osteoporosis (steroid dependence and oophorectomy). Patients were monitored for postoperative pain reduction, procedural including neurologic morbidity, and functional outcomes. Results Twenty of 25 patients (80%) had reduction in their visual analog pain score (VAS) at a median follow-up of 6.5 months; no patients worsened. Mean VAS declined from 8.8 to 4.7 postprocedurally (p Conclusion Sacroplasty is a safe and effective option for the palliation of radiation-induced and sacral insufficiency fractures in the oncologic population. References _