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Comparison of patterns and rates of cement leakage in percutaneous sacroplasty for sacral insufficiency fractures versus neoplasia

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Abstract

Objective

Percutaneous sacroplasty is a minimally invasive procedure which utilises injection of bone cement into the sacrum for stabilisation of osteoporotic sacral insufficiency fractures (SIF) and neoplastic lesions to relieve pain and improve function. While effective, cement leakage is an important complication associated with the procedure. This study aims to compare the incidence and patterns of the cement leakages following sacroplasty for SIF versus neoplasia and discuss the various patterns of cement leakage and their implications.

Materials and methods

This retrospective study analysed 57 patients who underwent percutaneous sacroplasty at a tertiary orthopaedic hospital. Patients were divided into 2 groups of SIF (n=46) and neoplastic lesions (n=11) based on their indication for sacroplasty. Pre- and post-procedural CT fluoroscopy was used to assess for cement leakage. The incidence and patterns of cement leakage were both compared among the two groups. A Fisher’s exact test was used for statistical analysis.

Results

Eleven (19%) patients had cement leakage on post-procedural imaging. The most common sites of cement leakage were into the presacral region (6), followed by sacroiliac joints (4), sacral foramina (3) and posterior sacral (1). There was a statistically significant higher incidence of leakage in the neoplastic group in comparison to SIF group (P-value <0.05). The incidence of cement leakage in the neoplastic group was 45% (n = 5/11) versus SIF 13% (n=6/46).

Conclusion

There was a statistically significant higher incidence of cement leak in sacroplasties conducted for the treatment of neoplastic lesions compared to those with sacral insufficiency fracture.

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Authors and Affiliations

  1. Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK

    S Ariyaratne, P Whittaker, SL James & R Botchu

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  1. S Ariyaratne
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  2. P Whittaker
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  3. SL James
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  4. R Botchu
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Correspondence to R Botchu.

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Ariyaratne, S., Whittaker, P., James, S. et al. Comparison of patterns and rates of cement leakage in percutaneous sacroplasty for sacral insufficiency fractures versus neoplasia. Skeletal Radiol 53, 93–98 (2024). https://doi.org/10.1007/s00256-023-04386-5

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  • DOI: https://doi.org/10.1007/s00256-023-04386-5

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