Introduction In elderly patients with reduced bone quality, insufficiency fractures of the OS sacrum are relatively common and are typically associated with intense, debilitating pain. The objective of our study was to determine the practicability of cement augmentation using a balloon catheter via individual approaches taking into consideration the complex anatomy of the sacrum and the course of the fracture, as well as the postinterventional determination of leakages and representation of the outcome pain.
Material and Methods In 30 patients with severe osteoporosis (23 women with an average age of 72.4 years, seven men with an average age of 68.7 years), a sacral fracture was detected by CT and MRT. This fracture was unilateral in 17 women and bilateral in the other patients. In order to achieve a cement distribution longitudinally in relation to the fracture, the balloon catheter was inserted into the OS sacrum via a hollow needle either from caudal to cranial, from dorsal to ventral or from lateral transiliac to medial. The balloon catheter was then inflated and deflated 1–3 times along the fracture in the respective direction, and the hollow space created was then filled with PMMA cement using a low-pressure procedure. A conventional radiograph in two planes and a control CT were then performed. Pain intensity was determined pre-intervention, on the second day post-intervention and 6 and 12 months post-intervention, using a visual analogue scale.
Results The balloon sacroplasty was performed successfully from a technical point of view in all patients. The radiographic and CT control showed sufficient cement distribution in the sacrum along the course of the fracture, whereby leakage could be ruled out. According to the visual analogue scale, the mean value for pain was 8.8 pre-intervention, there was a significant reduction in pain on the second postoperative day, with an average value of 2.7 (p<0.001), which was stable at 2.5 after 6 months and 2.3 after 12 months.
Discussion Approaches that take into account the anatomy of the OS sacrum and the course of the sacral fracture enable reliable augmentation with an optimum amount of cement. This makes balloon sacroplasty an effective treatment that has few complications for rapid and significant pain relief in patients with a sacral fracture.
Competing interests None.
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