Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures |
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Authors: | Ehab M Kamel Stefano Binaghi Daniel Guntern Elyazid Mouhsine Pierre Schnyder Nicolas Theumann |
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Institution: | (1) Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland;(2) Department of Diagnostic and Orthopaedic, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland;(3) Department of Radiology, Lausanne University Hospital-CHUV, 1011 Lausanne, Switzerland |
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Abstract: | Our aim was to assess the clinical outcome of patients who were subjected to long-axis sacroplasty for the treatment of sacral
insufficiency fractures. Nineteen patients with unilateral (n = 3) or bilateral (n = 16) sacral fractures were involved. Under
local anaesthesia, each patient was subjected to CT-guided sacroplasty using the long-axis approach through a single entry
point. An average of 6 ml of polymethylmethacrylate (PMMA) was delivered along the path of each sacral fracture. For each
individual patient, the Visual Analogue pain Scale (VAS) before sacroplasty and at 1, 4, 24 and 48 weeks after the procedure
was obtained. Furthermore, the use of analgesics (narcotic/non-narcotic) along with the evolution of post-interventional patient
mobility before and after sacroplasty was also recorded. The mean pre-procedure VAS was 8 ± 1.9 (range, 2 to 10). This rapidly
and significantly (P < 0.001) declined in the first week after the procedure (mean 4 ± 1.4; range, 1 to 7) followed by a gradual and significant
(P < 0.001) decrease along the rest of the follow-up period at 4 weeks (mean 3 ± 1.1; range, 1 to 5), 24 weeks (mean 2.2 ± 1.1;
range, 1 to 5) and 48 weeks (mean 1.6 ± 1.1; range, 1 to 5). Eleven (58%) patients were under narcotic analgesia before sacroplasty,
whereas 8 (42%) patients were using non-narcotics. Corresponding values after the procedure were 2/19 (10%; narcotic, one
of them was on reserve) and 10/19 (53%; non-narcotic). The remaining 7 (37%) patients did not address post-procedure analgesic
use. The evolution of post-interventional mobility was favourable in the study group as they revealed a significant improvement
in their mobility point scale (P < 0.001). Long-axis percutaneous sacroplasty is a suitable, minimally invasive treatment option for patients who present with
sacral insufficiency fractures. More studies with larger patient numbers are needed to explore any unrecognised limitations
of this therapeutic approach. |
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