A practical access for fluoroscopically‐guided percutaneous sacroplasty: Case report

Abstract

Background Sacral metastases represent the lowest percentage of invasion to the spine, however, as chemotherapy treatments progress, the cancer survival rate has become higher, and the percentage of sacral metastases has increased. Treatment options for sacrum metastases are surgery, radiotherapy, and minimally invasive techniques such as sacroplasty and radiofrequency ablation. Knowing the repercussions that advancing the needle anteriorly (viscera) or medially (sacral roots) can have during the sacroplasty we are describing a technique to perform c‐arm sacroplasty in coaxial vision, to identify the anterior sacral cortical bone that is in the limits of the pelvic viscera as well as the sacral foraminal line. Case presentation In the current report, we present a 75‐year‐old male patient with prostate cancer metastatic to S1, S2, S3 and iliac, with severe lumbar axial pain VAS 8/10. With a caudal tilt between 35‐45 degrees until aligning the sacrum in a coaxial view, a 11‐gauge Jamshidi needle is advanced from s3 to s1. The trajectory of the needle during the procedure is corroborated in AP and lateral, S1 is cemented, and the needle is withdrawn to cement S2 and S3. After the sacroplasty with the coaxial access, the patient reported VAS 1‐2/10. Conclusions It is important to offer an adequate quality of life to patients with sacral fractures, whether associated with cancer or sacral insufficiency fractures (SIF). Sacroplasty, being a recently described technique, can be a very viable option for these patients, that’s why it is important to have safe and reliable techniques to complement the approach of this minimally invasive technique.The coaxial access may be a safe and practical way to perform sacroplasty in these patients.

Sacroplasty for Sacral Insufficiency Fractures: Narrative Literature Review on Patient Selection, Technical Approaches, and Outcomes

“…In this approach, initially described by Silva-Ortiz et al, the fluoroscope is first set to AP view with a 15-degree cephalad tilt to identify the lateral limit of the S1 foramen [44]. The fluoroscope is then adjusted to a 35-45-degree caudad tilt to align the anterior and posterior aspect of the sacrum, thereby giving the coaxial view of the sacral bone.…”

Sacroiliac Joint Denervation—A Novel Approach to Target Sacral Lateral Branches: A Practical Approach

“…This article hereby describes a practical, anatomy informed, time and cost-efficient method to perform a strip lesion of the sacral lateral branch nerves using conventional RF. This technique utilizes a caudad view, in-plane, or ‘gun barrel’ approach to sacroiliac joint ablation using a single large bore, radiofrequency cannula without the need for specialized equipment that may be unavailable or restricted because of cost [ 5 , 6 ].…”