Fluoroscopic guided percutaneous sacroplasty utilizing a single curved needle: technical notes

Abstract

Purpose: Percutaneous sacroplasty is the current standard of care for the management of painful sacral insufficiency fractures, and has proven to provide significant pain relief and functional improvement for patients. Currently, there is no widely accepted standard technique for sacroplasty. In this study, we describe a new fluoroscopy guided technique using a single curved needle to treat sacral insufficiency fractures at any sacral level.

Methods: This is a retrospective case series and technical notes. A retrospective review of the pre-operative notes, procedure reports, and post-operative clinic visits was performed. Parameters recorded were pre-operative pain score, comorbidities, procedure details including radiation dose and duration, complications, and postoperative outcomes.

Results: From January 2023 to June 2024, four curved needle sacroplasties were performed on three patients (two females, one male) at our institution: two for bilateral sacral fractures in a single patient, one for a left sacral fracture, and one for a right sacral fracture. Patient ages ranged from 58 to 90. The average fluoroscopy time was 19.5 min (range: 13.7-24.9 min), and the average radiation dose was 774.8 mGy (range: 622.1-1027 mGy). No procedural complications were observed. Postoperatively, there was good functional improvement for all patients and VAS scores dropped by an average of 5.5 points, reflecting significant pain relief.

Conclusions: Percutaneous sacroplasty utilizing a curved needle is a novel technique for treating sacral insufficiency fractures. This technique allows the ability to inject cement in various directions with a single needle. This approach potentially reduces procedural time and radiation exposure.

Keywords: Curved needle; Interventional radiology; Sacral insufficiency fracture; Sacroplasty; Spine; Vertebroplasty.