gms | German Medical Science

Objective: To evaluate efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures.

Method: In this single-center retrospective observational study with prospectively collected data, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity on the visual analogue scale (VAS) were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum.

Results: Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3±0.5 to 2.3±1.0 (P<0.001) on the first postoperative day and to 1.3±1.9 (P<0.004) at follow-up (mean, 20.1 weeks). Slight cement extravasations were observed without evidence of being symptomatic. No major complications or procedure-related morbidity were noted.

Conclusions: From the limited experience in four patients, navigation-guided radiofrequency kyphoplasty appears to be a safe and effective treatment option for SIFs even though asymptomatic cement extravasation was noted. The use of navigation based on intraoperative 3D images simplifies the positioning of the navigated bone needles via the long axis approach. The radiofrequency kyphoplasty system provides the possibility to administer a sufficient amount of bone cement with a well-defined viscosity through the whole time of the procedure leading to high security and low cement extravasation. Sacroplasty provides rapid and enduring pain relief, and facilitates prompt mobilization.