Safety and efficacy of percutaneous sacroplasty for treatment of sacral insufficiency fractures: a systematic review

Sacral insufficiency fractures are a common source of back pain in the elderly and are associated with significant morbidity due to poor recognition and delays in diagnosis. Previous treatment modalities have centered primarily on bed rest, oral analgesia, early mobilization and physical therapy. However, in recent years sacroplasty has emerged as a viable treatment option for sacral insufficiency fractures. Earlier recovery with sacroplasty, reduced incidence of deep venous thrombosis, and earlier return to activities of daily living are some of the features that made this treatment modality more appealing than traditional conservative management. We undertook a systematic review of the literature to examine the efficacy of sacroplasty for treatment of sacral insufficiency fractures in the elderly population. Thirty-one articles were included in this study for final analysis. Cement extravasation was the most commonly reported complication; however, it was not found to have clinical significance in the majority of studies that reported this outcome. Two studies reported S1 radicular pain after the procedure while only one study reported a patient with persistent pain requiring reoperation (1/8 incidence, 12.5%). The mean reduction in pain score from pre-procedure to latest follow-up post-procedure [reported as visual analog scale (VAS)] was 5.8+1.3 for those studies that reported this figure. Overall, sacroplasty is a safe and effective procedure associated with low complication rate and consistent pain relief in patients with sacral insufficiency fractures.