Chapter 20 Percutaneous Sacroplasty
Sacral insufficiency fractures, which are commonly associated with osteoporosis, rheumatoid arthritis, and radiation therapy–related cancer bony metastasis, can be treated with percutaneous sacroplasty under fluoroscopic and CT guidance; procedure is the same in the vertebrae as in the sacrum [1]. Pain caused by sacral insufficiency fractures can be relieved immediately with percutaneous sacroplasty, and patients can be allowed to ambulate immediately after the procedure.
The possible mechanisms for the pain relief experienced after sacroplasty are as follows:
Indications
Indications for sacroplasty are as follows:
Prolonged difficulty in weight-bearing with severe tenderness on the median sacral crest and/or lateral sacral crest, and/or sacral ala on physical examination
Procedure
3. An intravenous injection of 30 mg ketorolac and 50 μg fentanyl with or without 2 to 3 mg midazolam is administered for anesthesia.
4. A 22-gauge, 10-cm block needle is placed in each sacral foramen, and contrast medium is injected under fluoroscopic guidance (Fig. 20-1A).
. If needed, the contrast medium is injected to confirm correct placement of the needle past the root and epidural space (Fig. 20-1B).
6. A 1% solution of lidocaine is infiltrated with another block needle to the targeted periosteum (Fig. 20-2).
. An 11-gauge, 10-cm vertebral needle is inserted into the skin incision and anchored to the targeted periosteum (Fig. 20-3).
10. The contrast medium is injected to ensure that there is no leakage into the epidural space, transforaminal space, or the venous system after the stylet of the vertebral needle is removed.
11. To reduce the pain from expanding the periosteum, an injection of less than 2 mL of 1% lidocaine can be given before the insertion of PMMA.
12. PMMA mixed with a radiopaque contrast agent, antibiotic, and barium powder is injected with the aid of the injector under continuous fluoroscopic vision in the lateral projection to ensure adequate filling of the lesions and to avoid PMMA leakage (Fig. 20-4).
Related posts:
Lateral Interbody Fusion Using the XLIF System
Minimally Invasive Percutaneous Lumbar Fusion Technique
Sacroiliac Joint Block and Neuroablation
Anterior Endoscopic Cervical Microdecompression of Disc and Foramen
Outcome Measurements for Minimally Invasive Percutaneous Spine Techniques
Spinal Cord Stimulation
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
