First Experience Using Navigation-Guided Radiofrequency Kyphoplasty for Sacroplasty in Sacral Insufficiency Fractures

Abstract

Purpose: To evaluate the efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures. Methods: In this single-center retrospective observational study, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum. Results: Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3???0.5 to 2.3???1.0 (p?<?0.001) on the first postoperative day and to 1.3???1.9 (p?<?0.004) at follow-up (mean, 20.1 weeks). Slight cement extravasations were observed without evidence of being symptomatic. No major complications or procedure-related morbidity were noted. Conclusion: From the limited experience in four patients, navigation-guided radiofrequency kyphoplasty appears to be a safe and effective treatment option for sacral insufficiency fractures even though asymptomatic cement extravasation was noted. The use of navigation based on intraoperative 3?D images simplifies the positioning of the navigated bone needles via the long axis approach. The radiofrequency kyphoplasty system provides the possibility to administer a sufficient amount of bone cement with a well-defined viscosity over the entire period of the procedure leading to high security and low cement extravasation. Sacroplasty provides rapid and enduring pain relief and facilitates prompt mobilization.

Radiofrequency sacroplasty (RFS) for the treatment of osteoporotic insufficiency fractures

“…As reported by Klingler et al [16] and Eichler et al [17], we also observed a significant pain reduction in all patients. Klingler et al [16] found asymptomatic PMMA leakages in 100 % of their cases and Eichler et al in 5.5 %, in contrast to 0 % in our study. The approaches selected were possibly disadvantageous, taking into account the complex anatomy of the sacrum, as the approach chosen in the two studies was via the long axis [22], whereas we chose an approach via the short or transiliac axis [23,24].…”

“…As early as the second postoperative day, a significant pain reduction to an average of 2.3 score points can be seen. This remained consistently stable over the further course, at 2.2 after 6 months and 2.1 after 12 months [15][16][17], we also treated 20 patients with osteoporotic insufficiency fractures of the sacrum by means of radiofrequency-guided cement insertion. As reported by Klingler et al [16] and Eichler et al [17], we also observed a significant pain reduction in all patients.…”

“…This remained consistently stable over the further course, at 2.2 after 6 months and 2.1 after 12 months [15][16][17], we also treated 20 patients with osteoporotic insufficiency fractures of the sacrum by means of radiofrequency-guided cement insertion. As reported by Klingler et al [16] and Eichler et al [17], we also observed a significant pain reduction in all patients. Klingler et al [16] found asymptomatic PMMA leakages in 100 % of their cases and Eichler et al in 5.5 %, in contrast to 0 % in our study.…”

“…The safe feasibility of CT-guided balloon sacroplasty was later confirmed in a cadaver study [12] and in various clinical studies [4,13,14]. For RFS, a case report [15] and initial investigations [16,17] have also shown good results with regard to pain reduction.…”

Comparison of the 18-month outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study

“…However, the positive effect of sacroplasty can be counteracted by complications, with not always asymptomatic cement leakages at the forefront [8,12,27,28], although most do remain free of symptoms [22,29]. Cement leakage can be further reduced in BSP by the use of a balloon catheter, with which a cavity is created in the fracture zone and potentially leaking fracture gaps are compressed [13,16,21,25].…”