Skip to main content
SpringerLink
Log in

Sacral Insufficiency Fractures: a Review of Risk Factors, Clinical Presentation, and Management

  • Other Pain (AD Kaye and N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Sacral insufficiency fractures (SIF) are a common and often underdiagnosed source of low back pain. In patients with SIF, there is both a compromised sacroiliac joint and weakened sacrum, resulting in decreased resistance to torsional stress, leading to fracture. While conservative medical management is a safe option, minimally invasive intervention may provide improved short and long-term relief of low back pain in patients presenting with SIF. This comprehensive review is undertaken to provide an update to the current understanding of SIF with description of risk factors, clinical presentation, and management.

Recent Findings

Sacroplasty is a minimally invasive procedure in which polymethylmethacrylate (PMMA) cement is inserted into bone to improve its structural integrity and alleviate symptoms. Balloon sacroplasty (BSP) has also been successful in alleviating pain with minimal cement leakage in SIF patients. Various other interventional techniques, including navigation-assisted screw fixation have been used to address SIF and have shown improvement in pain with minimal side effects.

Summary

This review included various modalities of treatments available to manage SIF. This review shows that in comparison with nonsurgical management, sacroplasty has been shown to have greater pain reduction and improved mobility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Dieleman JL, Baral R, Birger M, Bui AL, Bulchis A, Chapin A, et al. US spending on personal health care and public health, 1996-2013. JAMA. 2016;316:2627–46.

    PubMed  PubMed Central  Google Scholar 

  2. Dieleman JL, Squires E, Bui AL, Campbell M, Chapin A, Hamavid H, et al. Factors associated with increase in US health care spending, 1996-2013. JAMA. 2017;318:1668–78.

    PubMed  PubMed Central  Google Scholar 

  3. Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Trescot AM, Blank S, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2017;20:S3–S92.

    PubMed  Google Scholar 

  4. Sanger N, Bhatt M, Singhal N, Ramsden K, Baptist-Mohseni N, Panesar B, et al. Adverse outcomes associated with prescription opioids for acute low back pain: a systematic review and meta-analysis. Pain Physician. 2019;22:119–38.

    PubMed  Google Scholar 

  5. U.S. Department of Health and Human Services. Pain management best practices inter-agency task force. Final report on pain management best practices: updates, gaps, inconsistencies, and recommendations. May 9, 2019. https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html.

  6. Manchikanti L, Sanapati J, Benyamin RM, Atluri S, Kaye AD, Hirsch JA. Reframing the prevention strategies of the opioid crisis: focusing on prescription opioids, fentanyl, and heroin epidemic. Pain Physician. 2018;21:309–26.

    PubMed  Google Scholar 

  7. • Manchikanti L, Soin A, Mann DP, Bakshi S, Pampati V, Hirsch JA. Reversal of growth of utilization of interventional techniques in managing chronic pain in Medicare population post affordable care act. Pain Physician. 2017;20:551–67. This is the latest manuscript describing the utilization of interventional techniques in managing chronic pain in the Medicare population. This updated analysis details various categories of procedures and their patterns of utilization.

    PubMed  Google Scholar 

  8. Manchikanti L, Soin A, Mann DP, Bakshi S, Pampati V, Kaye AD, et al. Utilization patterns of facet joint interventions in managing spinal pain: a retrospective cohort study in the US fee-for-service Medicare population. Curr Pain Headache Rep. 2019;23:73.

    PubMed  Google Scholar 

  9. Manchikanti L, Soin A, Mann DP, Bakshi S, Pampati V, Hirsch JA. Comparative analysis of utilization of epidural procedures in managing chronic pain in the Medicare population: pre and post affordable care act. Spine (Phila Pa 1976). 2019;44:220–32.

    Google Scholar 

  10. • Manchikanti MV, Manchikanti L, Kaye AD, Pampati V, Hirsch JA. Usage patterns of sacroiliac joint injections - a comparative evaluation of pre and post Affordable Care Act in Medicare population. IPM Reports. 2018;2:157–66. This manuscript describes the utility of sacroiliac joint injections which increased from 2009 to 2016.

    Google Scholar 

  11. Manchikanti L, Pampati V, Benyamin RM, Hirsch JA. Cost calculation methodology exacerbates site-of-service differentials by 10- to 18-fold for soft tissue and joint injections in hospital outpatient departments. IPM Reports. 2017;1:183–9.

    Google Scholar 

  12. Lee JH, Shin KS, Park SJ, Lee GJ, Lee CH, Kim DH, et al. Comparison of clinical efficacy between transforaminal and interlaminar epidural injections in lumbosacral disc herniation: a systematic review and meta-analysis. Pain Physician. 2018;21:433–48.

    PubMed  Google Scholar 

  13. Lee JH, Kim DH, Kim DH, Shin KS, Park SJ, Lee GJ, et al. Comparison of clinical efficacy of epidural injection with or without steroid in lumbosacral disc herniation: a systematic review and meta-analysis. Pain Physician. 2018;21:449–68.

    PubMed  Google Scholar 

  14. Sanapati J, Manchikanti L, Atluri S, Jordan S, Albers SL, Pappolla MA, et al. Do regenerative medicine therapies provide long-term relief in chronic low back pain: a systematic review and metaanalysis. Pain Physician. 2018;21:515–40.

    PubMed  Google Scholar 

  15. Tran ZV, Ivashchenko A, Brooks L. Sacroiliac joint fusion methodology - minimally invasive compared to screw-type surgeries: a systematic review and meta-analysis. Pain Physician. 2019;22:29–40.

    PubMed  Google Scholar 

  16. Shen J, Xu S, Xu S, Ye S, Hao J. Fusion or not for degenerative lumbar spinal stenosis: a meta-analysis and systematic review. Pain Physician. 2018;21:1–8.

    PubMed  Google Scholar 

  17. Coulter ID, Crawford C, Vernon H, Hurwitz EL, Khorsan R, Booth MS, et al. Manipulation and mobilization for treating chronic nonspecific neck pain: a systematic review and meta-analysis for an appropriateness panel. Pain Physician. 2019;22:E55–70.

    PubMed  PubMed Central  Google Scholar 

  18. Navani A, Manchikanti L, Albers SL, Latchaw RE, Sanapati J, Kaye AD, et al. Responsible, safe, and effective use of biologics in the management of low back pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2019;22:S1–74.

    PubMed  Google Scholar 

  19. Zhiyong C, Yun T, Hui F, Zhongwei Y, Zhaorui L. Unilateral versus bilateral balloon kyphoplasty for osteoporotic vertebral compression fractures: a systematic review of overlapping meta-analyses. Pain Physician. 2019;22:15–28.

    PubMed  Google Scholar 

  20. Manchikanti L, Pampati V, Benyamin RM, Hirsch JA. Declining utilization of percutaneous epidural adhesiolysis in Medicare population: evidence-based or over-regulated? IPM Rep. 2018;2:9–18.

    Google Scholar 

  21. Chen X, Guo W, Li Q, Ou Z, Lao Z, Liu Y, et al. Is unilateral percutaneous kyphoplasty superior to bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures? Evidence from a systematic review of discordant meta-analyses. Pain Physician. 2018;21:327–36.

    PubMed  Google Scholar 

  22. Manchikanti L, Sanapati J, Pampati V, Kaye AD, Hirsch JA. Utilization of vertebral augmentation procedures in the United States: a comparative analysis in Medicare fee-for-service population pre- and post-2009 trials. Curr Pain Headache Rep. 2019;23:73.

    PubMed  Google Scholar 

  23. Xiang GH, Tong MJ, Lou C, Zhu SP, Guo WJ, Ke CR. The role of unilateral balloon kyphoplasty for the treatment of patients with OVCFS: a systematic review and meta-analysis. Pain Physician. 2018;21:209–18.

    PubMed  Google Scholar 

  24. Zadro JR, Shirley D, Ferreira M, Carvalho Silva AP, Lamb SE, Cooper C, et al. Is vitamin D supplementation effective for low back pain? A systematic review and meta-analysis. Pain Physician. 2018;21:121–45.

    PubMed  Google Scholar 

  25. Sun H, Lu PP, Liu YJ, Yang X, Zhou PH, Shen XF, et al. Can unilateral kyphoplasty replace bilateral kyphoplasty in treatment of osteoporotic vertebral compression fractures? A systematic review and meta-analysis. Pain Physician. 2016;19:551–63.

    PubMed  Google Scholar 

  26. Kortman K, Ortiz O, Miller T, Brook A, Tutton S, Mathis J, et al. Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions. J Neurointerv Surg. 2013;5:461–6.

    PubMed  Google Scholar 

  27. • Park JW, Park SM, Lee HJ, Lee CK, Chang BS, Kim H. Mortality following benign sacral insufficiency fracture and associated risk factors. Arch Osteoporos. 2017;12:100. An important manuscript describing mortality following benign sacral insufficiency fractures and associated risk factors. Appropriate management will reduce mortality, as well as morbidity.

    PubMed  Google Scholar 

  28. • Frey ME, Warner C, Thomas SM, Johar K, Singh H, Mohammad MS, et al. Sacroplasty: a ten-year analysis of prospective patients treated with percutaneous sacroplasty: literature review and technical considerations. Pain Physician. 2017;20:E1063–72. This manuscript is one of the early manuscripts describing a 10 year analysis of percutaneous sacroplasty and includes a literature review.

    PubMed  Google Scholar 

  29. Lourie H. Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly. JAMA. 1982;248:715–7.

    CAS  PubMed  Google Scholar 

  30. Rawlings CE 3rd, Wilkins RH, Martinez S, Wilkinson RH Jr. Osteoporotic sacral fractures: a clinical study. Neurosurgery. 1988;22:72–6.

    PubMed  Google Scholar 

  31. Sudhir G, LK K, Acharya S, Chahal R. Sacral insufficiency fractures mimicking lumbar spine pathology. Asian Spine J. 2016;10:558–64.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Grasland A. Sacral insufficiency fractures. Arch Intern Med. 2011;156:668–74.

    Google Scholar 

  33. Tamaki Y, Nagamachi A, Inoue K, Takeuchi M, Sugiura K, Omichi Y, et al. Incidence and clinical features of sacral insufficiency fracture in the emergency department. Am J Emerg Med. 2017;35:1314–6.

    PubMed  Google Scholar 

  34. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221:537–67.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Poiliot AJ, Zwirner J, Doyle T, Hammer N. A systematic review of the normal sacroiliac joint anatomy and adjacent tissues for pain physicians. Pain Physician. 2019;22:E247–74.

    Google Scholar 

  36. Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N. Risk factors for sacral insufficiency fractures in cervical cancer after whole pelvic radiation therapy. Anticancer Res. 2019;39:361–7.

    PubMed  Google Scholar 

  37. Zhang L, He Q, Jiang M, Zhang B, Zhong X, Zhang R. Diagnosis of insufficiency fracture after radiotherapy in patients with cervical cancer: contribution of technetium Tc 99m-labeled methylene diphosphonate single-photon emission computed tomography/computed tomography. Int J Gynecol Cancer. 2018;28:1369–76.

    PubMed  Google Scholar 

  38. Bostel T, Nicolay NH, Welzel T, Bruckner T, Mattke M, Akbaba S, et al. Sacral insufficiency fractures after high-dose carbon-ion based radiotherapy of sacral chordomas. Radiat Oncol. 2018;13:1–7.

    Google Scholar 

  39. Kawamoto T, Ito K, Furuya T, Sasai K, Karasawa K. Sacral insufficiency fracture after stereotactic body radiation therapy for sacral metastasis. Clin Case Rep. 2018;6:2293–4.

    PubMed  PubMed Central  Google Scholar 

  40. Speziali A, Tei MM, Placella G, Chillemi M, Cerulli G. Postpartum sacral stress fracture: an atypical case report. Case Rep Orthop. 2015;2015:704393.

    PubMed  PubMed Central  Google Scholar 

  41. Hmida B, Boudokhane S, Migaou H, Kalai A, Jellad A, Salah ZB. Postpartum sacral stress fracture associated with mechanical sacroiliac joint disease: a case report. Medicine (Baltimore). 2018;97:e11735.

    Google Scholar 

  42. Kinoshita H, Miyakoshi N, Kobayashi T, Abe T, Kikuchi K, Shimada Y. Comparison of patients with diagnosed and suspected sacral insufficiency fractures. J Orthop Sci. 2019;24:702–7.

    PubMed  Google Scholar 

  43. Yoo JI, Ha YC, Ryu HJ, Chang GW, Lee YK, Yoo MJ, et al. Teriparatide treatment in elderly patients with sacral insufficiency fracture. J Clin Endocrinol Metab. 2017;102:560–5.

    PubMed  Google Scholar 

  44. Kim YY, Chung BM, Kim WT. Lumbar spine MRI versus non-lumbar imaging modalities in the diagnosis of sacral insufficiency fracture: a retrospective observational study. BMC Musculoskelet Disord. 2018;19:257.

    PubMed  PubMed Central  Google Scholar 

  45. Expert Panel on Musculoskeletal Imaging, Bencardino JT, Stone TJ, Roberts CC, Appel M, Baccei SJ, et al. ACR appropriateness criteria® stress (fatigue/insufficiency) fracture, including sacrum, excluding other vertebrae. J Am Coll Radiol. 2017;14:S293–306.

    Google Scholar 

  46. Yang SC, Tsai TT, Chen HS, Fang CJ, Kao YH, Tu YK. Comparison of sacroplasty with or without balloon assistance for the treatment of sacral insufficiency fractures. J Orthop Surg (Hong Kong). 2018;26:230949901878257.

    Google Scholar 

  47. Parry SM, Puthucheary ZA. The impact of extended bed rest on the musculoskeletal system in the critical care environment. Extreme Physiol Med. 2015;4:16.

    Google Scholar 

  48. Lin JT, Lane JM. Sacral stress fractures. J Women’s Health. 2003;12:879–88.

    Google Scholar 

  49. • Su B, O’Connor JP. NSAID therapy effects on healing of bone, tendon, and the enthesis. J Appl Physiol. 2013;115:892–9. This study demonstrates no benefit of augmentation of sacroiliac screws with sacroplasty.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. García-Martínez O, De Luna-Bertos E, Ramos-Torrecillas J, Manzano-Moreno FJ, Ruiz C. Repercussions of NSAIDS drugs on bone tissue: the osteoblast. Life Sci. 2015;123:72–7.

    PubMed  Google Scholar 

  51. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007;370:657–66.

    CAS  PubMed  Google Scholar 

  52. • Ma S, Goh EL, Jin A, Bhattacharya R, Boughton OR, Patel B, et al. Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties. Sci Rep. 2017;7:43399. A long-term follow up of patients treated with sacroplasty.

    PubMed  PubMed Central  Google Scholar 

  53. Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016;31:16–35.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010;25:404–14.

    CAS  PubMed  Google Scholar 

  55. Alkhiary Y, Gerstenfeld L, Krall E, Westmore M, Sato M, Mitlak BH, et al. Enhancement of experimental fracture-healing by systemic administration of recombinant human parathyroid hormone (PTH 1-34). J Bone Joint Surg Am. 2005;87:731–41.

    PubMed  Google Scholar 

  56. Carvalho N, Voss L, Almeida MO, Salgado CL, Bandeira F. Atypical femoral fractures during prolonged use of bisphosphonates: short-term responses to strontium ranelate and teriparatide. J Clin Endocrinol Metab. 2011;96:2675–80.

    CAS  PubMed  Google Scholar 

  57. Zhang D, Potty A, Vyas P, Lane J. The role of recombinant PTH in human fracture healing: a systematic review. J Orthop Trauma. 2014;28:57–62.

    PubMed  Google Scholar 

  58. Baillieul S, Guinot M, Dubois C, Prunier A, Mahler F, Gaudin P. Set the pace of bone healing–treatment of a bilateral sacral stress fracture using teriparatide in a long-distance runner. Joint Bone Spine. 2017;84:499–500.

    PubMed  Google Scholar 

  59. Tsai JN, Uihlein AV, Burnett-Bowie SM, Neer RM, Derrico NP, Lee H, et al. Effects of two years of teriparatide, denosumab, or both on bone microarchitecture and strength (DATA-HRpQCT study). J Clin Endocrinol Metab. 2016;101:2023–30.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Choi KC, Shin SH, Lee DC, Shim HK, Park CK. Effects of percutaneous sacroplasty on pain and mobility in sacral insufficiency fracture. J Korean Neurosurg Soc. 2017;60:60–6.

    PubMed  Google Scholar 

  61. Onen MR, Yuvruk E, Naderi S. Reliability and effectiveness of percutaneous sacroplasty in sacral insufficiency fractures. J Clin Neurosci. 2015;22:1601–8.

    PubMed  Google Scholar 

  62. Andresen R, Radmer S, Wollny M, Andresen JR, Nissen U, Schober HC. CT-guided cement sacroplasty (CSP) as pain therapy in non-dislocated insufficiency fractures. Eur J Orthop Surg Traumatol. 2017;27:1045–50.

    PubMed  PubMed Central  Google Scholar 

  63. Andresen R, Radmer S, Andresen JR, Schober HC. Comparison of the 18-month outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study. Eur Spine J. 2017;26:3235–40.

    PubMed  Google Scholar 

  64. Sanders D, Fox J, Starr A, Sathy A, Chao J. Transsacral-transiliac screw stabilization. J Orthop Trauma. 2016;30:469–73.

    PubMed  Google Scholar 

  65. Walker JB, Mitchell SM, Karr SD, Lowe JA, Jones CB. Percutaneous transiliac–transsacral screw fixation of sacral fragility fractures improves pain, ambulation, and rate of disposition to home. J Orthop Trauma. 2018;32:452–6.

    PubMed  Google Scholar 

  66. Mehling I, Hessmann MH, Rommens PM. Stabilization of fatigue fractures of the dorsal pelvis with a trans-sacral bar. Operative technique and outcome. Injury. 2012;43:446–51.

    PubMed  Google Scholar 

  67. Oberkircher L, Masaeli A, Bliemel C, Debus F, Ruchholtz S, Krüger A. Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens—a biomechanical investigation. Spine J. 2016;16:226–32.

    PubMed  Google Scholar 

  68. Maki S, Nakamura K, Yamauchi T, Suzuki T, Horii M, Kawamura K, et al. Lumbopelvic fixation for sacral insufficiency fracture presenting with sphincter dysfunction. Case Rep Orthop. 2019;2019:1–4.

    Google Scholar 

  69. Collinge CA, Crist BD. Combined percutaneous iliosacral screw fixation with sacroplasty using resorbable calcium phosphate cement for osteoporotic pelvic fractures requiring surgery. J Orthop Trauma. 2016;30:e217–22.

    PubMed  Google Scholar 

  70. Dmytriw AA, Talla K, Smith R. Percutaneous sacroplasty for the management of painful pathologic fracture in a multiple myeloma patient: case report and review of the literature. Neuroradiol J. 2017;30:80–3.

    CAS  PubMed  Google Scholar 

  71. Yoong J, Chandra RV, William L, Franco M, Goldschlager T, Runacres F, et al. Percutaneous sacroplasty for painful bone metastases: a case report. Pain Pract. 2017;17:945–51.

    PubMed  Google Scholar 

  72. Moussazadeh N, Laufer I, Werner T, Krol G, Boland P, Bilsky MH, et al. Sacroplasty for cancer-associated insufficiency fractures. Neurosurgery. 2015;76:446–50.

    PubMed  Google Scholar 

  73. Hutson N, Hung JC, Puttanniah V, Lis E, Laufer I, Gulati A. Interventional pain management for sacroiliac tumors in the oncologic population: a case series and paradigm approach. Pain Med. 2017;18:959–68.

    PubMed  Google Scholar 

  74. Andresen R, Radmer S, Lüdtke C, Kamusella P, Wissgott C, Schober H. Balloon sacroplasty as a palliative pain treatment in patients with metastasis-induced bone destruction and pathological fractures. RoFo. 2014;186:881–6.

    CAS  PubMed  Google Scholar 

  75. Gupta AC, Chandra RV, Yoo AJ, Leslie-Mazwi TM, Bell DL, Mehta BP, et al. Safety and effectiveness of sacroplasty: a large single-center experience. AJNR Am J Neuroradiol. 2014;35:2202–6.

    CAS  PubMed  Google Scholar 

  76. Pereira LP, Clarençon F, Cormier É, Rose M, Jean B, Le Jean L, et al. Safety and effectiveness of percutaneous sacroplasty: a single-Centre experience in 58 consecutive patients with tumours or osteoporotic insufficient fractures treated under fluoroscopic guidance. Eur Radiol. 2013;23:2764–72.

    PubMed  Google Scholar 

  77. Soo Park H, Cho S, Yeon Kim D, Hyo Kim C, Kyung Chung R, Youn Jin Kim A. Percutaneous sacroplasty under fluoroscopic guidance combined with epidurogram for sacral insufficiency fracture resulting from metastatic tumor and osteoporosis. Pain Physician. 2016;19:473–80.

    Google Scholar 

  78. Worts PR, Chandler GS III. Office-based kyphoplasty: a viable option using local anesthesia with oral sedation. Pain Physician. 2019;22:177–85.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Ivan Urits, Vwaire Orhurhu, Thomas Simopoulos & Cyrus Yazdi

  2. Department of Anesthesia, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Jessica Callan, Nishita V. Maganty & Sara Pousti

  3. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Rachel J. Kaye & Alan D. Kaye

  4. Tulane School of Medicine, New Orleans, LA, USA

    Lauren K. Eng

  5. Pain Management Centers of America, Louisville, KY, USA

    Laxmaiah Manchikanti

  6. Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA

    Omar Viswanath

  7. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA

    Omar Viswanath

  8. Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Omar Viswanath

Authors
  1. Ivan Urits
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vwaire Orhurhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jessica Callan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nishita V. Maganty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara Pousti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Simopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cyrus Yazdi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rachel J. Kaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lauren K. Eng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alan D. Kaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Laxmaiah Manchikanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Omar Viswanath
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivan Urits.

Ethics declarations

Conflict of Interest

Ivan Urits, Vwaire Orhurhu, Jessica Callan, Nishita V. Maganty, Sara Pousti, Thomas Simopoulos, Cyrus Yazdi, Rachel J. Kaye, Lauren K. Eng, Alan D. Kaye, Laxmaiah Manchikanti, and Omar Viswanath declared that they have no conflict of interest.

Alan Kaye is a Section Editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Other Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Urits, I., Orhurhu, V., Callan, J. et al. Sacral Insufficiency Fractures: a Review of Risk Factors, Clinical Presentation, and Management. Curr Pain Headache Rep 24, 10 (2020). https://doi.org/10.1007/s11916-020-0848-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-020-0848-z

Keywords

Search

Navigation