Should I Perform Computed Tomography–guided Sacroplasty? Key Factors to Consider

Purpose or Learning Objective: (1) To describe computed tomography–guided percutaneous sacroplasty as a treatment for sacral insufficiency fractures; (2) to review the efficacy of the technique in a series of patients with symptomatic sacral osteoporotic fractures in our population; and (3) to study outcome predictors of clinical benefit and possible complications of the procedure.

Methods or Background: This retrospective study included 31 consecutive patients with sacral insufficiency fractures treated in our hospital between 2012 and 2024, using sacroplasty under computed tomography fluoroscopy guidance. All patients underwent radiologic evaluation before the procedure (magnetic resonance imaging or scintigraphy). The Visual Analog Score was assessed before treatment and then 3 months afterward to describe clinical outcomes. Complications during and after the procedure were reported.

Results or Findings: Mean age of the patients was 77.8 years (standard deviation [SD] 9.8 [range: 51–92]; 23 were female (74.2%). On average, computed tomography–guided sacroplasty was performed 29.47 days after the diagnosis of fracture (SD 14.47 [range: 7–45]). The approach was unilateral (n = 5) or bilateral sacral alae (n = 26) in all patients, and an average volume of cement of 3.61 mL (SD 2.5 [range: 2–7]) was injected at each sacral fracture site. Twelve patients underwent vertebroplasty of other vertebrae during the same procedure. Technical success was achieved in almost all patients. Four patients developed small asymptomatic cement leaks into the sacral foramen, without any significant neurologic repercussions; six into the anterior pelvic venous plexus, without any vascular complications; and one patient had a cement leak to the L5–S1 intervertebral disk. Patients showed significant pain relief defined as a Visual Analog Scale rate decrease > 3 points at 3 months after computed tomography–guided sacroplasty (P < 0.05). Volume of cement injected was independent of pain relief and functional improvement after the procedure (P > 0.05).

Conclusion: Computed tomography–guided percutaneous sacroplasty is a reliable, safe, and highly effective technique for pain relief in patients with insufficiency sacral fractures, with a significant functional improvement and no clinically relevant complications.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
02 June 2025