SEATTLE — Percutaneous sacroplasty seems to be a safe, effective therapy for painful sacral insufficiency, according to a multicenter study presented at the annual meeting of the North American Spine Society.
“The rate of improvement is rapid, with a 50% or better reduction in pain even before patients left the office. Pain reduction occurs primarily within the first 3 months and is sustained to 1 year,” said Dr. Michael Frey of the Physiatric Association of Spine, Sport, and Occupational Rehabilitation in Fort Meyers, Fla. Sacral insufficiency fractures are a known cause of pain in patients with weakened bone, with a natural history similar to that of vertebral compression fractures. Symptoms gradually resolve, but recovery is slow and patients often resort to opioid analgesics for relief.
Previous studies have shown that injection of polymethylmethacrylate (PMMA) relieves pain quickly and thoroughly by stabilizing the fracture. However, those studies were small, and their follow-up intervals were 2–16 weeks, Dr. Frey said.
In this prospective, observational cohort study, 25 consecutive sacral insufficiency fracture patients were treated with sacro- plasty. There were 17 women and 8 men with a mean age of 74 years and a mean duration of pain of 41 days. Pain level was assessed using the visual analog scale (VAS), and patient satisfaction and analgesic use were determined. Each procedure was performed under light intravenous conscious sedation and fluoroscopic control, without use of computed tomography. Two bone trocars were inserted between the sacral foramen and sacroiliac joint. About 2–3 cc of PMMA were injected through each trocar under coronal view, Dr. Frey said.
At 1 year, 23 of the 25 patients were available for follow-up. One patient had died from unrelated pulmonary disease. The mean VAS score, which was 7.3 at baseline, plunged to 2.7 immediately post procedure, and at 1 year, was 0.3. Improvement was statistically significant at 1 year and at each follow-up interval (2, 4, 12, and 24 weeks). “We saw a dramatic reduction in the use of opioid analgesics and what we would expect to be an increase in the use of nonopioid pain medications,” he said.