Introduction Percutaenous vertebroplasty has a well-established role in the treatment of pathologic fractures in patients with multiple myeloma. Despite this, there is a scarcity of literature surrounding its use and efficacy in the sacrum. We present a case of successful symptom resolution in a patient with painful sacral fracture following sacroplasty.
An 81 year-man with multiple myeloma presented to the hematology/oncology clinic with a history of excruciating pain while seated. The impact of this pain on his quality of life subjectively was rated to be particularly high. Plain radiographs of the sacrum confirmed the presence of pathologic fracture within the body of S2, later characterized with computed tomography. Under fluoroscopic guidance, polymethyl methacrylate (PMMA) bone cement was injected via an 18 gage needle using a far-lateral approach. No immediate post-procedural complications occurred, such as foraminal extravasation and venous injection. The patient reported himself to be pain-free one day following the procedure and this remains the case to-date at two years of follow-up.
Discussion Sacroplasty is technically feasible and can provide durable relief of symptoms in patients with both painful pathologic fractures of the sacrum. It is likely underused and can offer tremendous benefit to myeloma patients. Analgesia intolerance and functional obstacles to quality of life (e.g., sitting up) should be common clinical considerations. Important technical considerations include cement volume delivered and the potential for complications.
Disclosures A. Dmytriw: None. R. Smith: None.
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