Skip to main content
SpringerLink
Log in

The “Eiffel Tower” technique: novel long-axis sacroplasty under electromagnetic navigation assistance; feasibility and descriptive study

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To describe a novel long-axis multimodal navigation assisted technique — the so-called Eiffel Tower technique — aimed at integrating recent technological improvements for the routine treatment of sacral insufficiency fractures.

Materials and methods

The long-axis approach described in the present study aimed at consolidating the sacral bone according to biomechanical considerations. The purpose was (i) to cement vertically the sacral alae all along and within the lateral fracture lines, resembling the pillars of a tower, and (ii) to reinforce cranially with a horizontal S1 landing zone (or dense central bone) resembling the first level of the tower. An electromagnetic navigation system was used in combination with CT and fluoroscopic guidance to overtop extreme angulation challenges. All patients treated between January 2019 and October 2021 in a single tertiary center were retrospectively reviewed.

Results

A description of the technique is provided. Twelve female patients (median age: 80 years [range: 32 to 94]) were treated for sacral insufficiency fractures with the “Eiffel Tower” technique. The median treatment delay was 8 weeks (range: 3 to 20) and the initial median pain assessed by the visual analogue scale was 7 (range: 6 to 8). Pain was successfully relieved (visual analogue score < 3) for 9 patients (75%) and persisted for 2 patients (17%). One patient was lost during the follow-up. No complication was noted.

Conclusion

The “Eiffel Tower” multimodal cementoplasty integrates recent technological developments, in particular electromagnetic navigation, with the purpose of reconstructing the biomechanical chain of the sacral bone.

Key Points

• Sacral insufficiency fractures are common and can be efficiently treated with percutaneous sacroplasty.

• The long axis sacroplasty approach can be challenging given both the shape of the sacral bone and the angulation to reach the target lesion.

• The “Eiffel Tower” technique is a novel approach using electromagnetic navigation to expand the concept of the long axis route, adding a horizontal S1 landing zone.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AP :

Antero-posterior

CBCT :

Cone-beam CT

CT :

Computed tomography

EMNS:

Electromagnetic navigation system

MRI :

Magnetic resonance imaging

PC :

Percutaneous cementoplasty

PMMA :

Poly-methyl-methacrylate

SI :

Sacroiliac

SIF :

Sacral insufficiency fracture

SIJ :

Sacroiliac joint

References

  1. Lourie H (1982) Spontaneous osteoporotic fracture of the sacrum: an unrecognized syndrome of the elderly. JAMA 248:715–717

    Article  CAS  Google Scholar 

  2. Santolini E, Kanakaris NK, Giannoudis PV (2020) Sacral fractures: issues, challenges, solutions. EFORT Open Rev 5:299–311

    Article  Google Scholar 

  3. Urits I, Orhurhu V, Callan J et al (2020) Sacral insufficiency fractures: a review of risk factors, clinical presentation, and management. Curr Pain Headache Rep 24:10

    Article  Google Scholar 

  4. Pereira LP, Clarençon F, Cormier E et al (2013) 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 23:2764–2772

    Article  Google Scholar 

  5. Lin JT, Lane JM (2003) Sacral Stress Fractures. Journal of Women's Health 12:879–888

  6. Garant M (2002) Sacroplasty: a new treatment for sacral insufficiency fracture. J Vasc Interv Radiol 13:1265–1267

  7. Pommersheim W, Huang-Hellinger F, Baker M, Morris P (2003) Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol 24:1003–1007

  8. Frey ME, Warner C, Thomas SM et al (2017) Sacroplasty: a ten-year analysis of prospective patients treated with percutaneous sacroplasty: literature review and technical considerations. Pain Physician 20:E1063–e1072

    Google Scholar 

  9. Smith DK, Dix JE (2006) Percutaneous sacroplasty: long-axis injection technique. AJR Am J Roentgenol 186:1252–1255

  10. Kao F-C, Hsu Y-C, Chen T-S, Liu P-H, Tu Y-K (2021) Combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance for osteoporotic sacral insufficiency fracture. J Orthop Surg Res 16:269–269

  11. Frey ME, Depalma MJ, Cifu DX, Bhagia SM, Carne W, Daitch JS (2008) Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J 8:367–373

    Article  Google Scholar 

  12. Frey ME, DePalma MJ, Cifu DX, Bhagia SM, Daitch JS (2007) Efficacy and safety of percutaneous sacroplasty for painful osteoporotic sacral insufficiency fractures: a prospective, multicenter trial. Spine (Phila Pa 1976) 32:1635–1640

    Article  Google Scholar 

  13. Durand P, Moreau-Gaudry A, Silvent AS et al (2017) Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: a prospective randomized clinical trial. PLoS One 12:e0173751

    Article  Google Scholar 

  14. Moulin B, Tselikas L, De Baere T et al (2020) CT guidance assisted by electromagnetic navigation system for percutaneous fixation by internal cemented screws (FICS). Eur Radiol 30:943–949

    Article  Google Scholar 

  15. Teriitehau C, Rabeh H, Pessis E, Sénéchal Q, Besse F, Bravetti M (2020) Reduction of patient radiation dose during percutaneous CT vertebroplasty: impact of a new computer-assisted navigation (CAN) system. Radioprotection 55:11–16

    Article  CAS  Google Scholar 

  16. Mahmood B, Pasternack J, Razi A, Saleh A (2019) Safety and efficacy of percutaneous sacroplasty for treatment of sacral insufficiency fractures: a systematic review. J Spine Surg 5:365–371

    Article  Google Scholar 

  17. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 221:537–567

    Article  CAS  Google Scholar 

  18. Peretz AM, Hipp JA, Heggeness MH (1998) The internal bony architecture of the sacrum. Spine (Phila Pa 1976) 23:971–974

    Article  CAS  Google Scholar 

  19. Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81

    Article  CAS  Google Scholar 

  20. Kinoshita H, Miyakoshi N, Kobayashi T, Abe T, Kikuchi K, Shimada Y (2019) Comparison of patients with diagnosed and suspected sacral insufficiency fractures. J Orthop Sci 24:702–707

    Article  Google Scholar 

  21. Deschamps F, de Baere T, Hakime A et al (2016) Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol 26:1631–1639

    Article  Google Scholar 

  22. Premat K, Clarençon F, Bonaccorsi R, Degos V, Cormier É, Chiras J (2017) Reinforced cementoplasty using dedicated spindles in the management of unstable malignant lesions of the cervicotrochanteric region. Eur Radiol 27:3973–3982

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, 47, Bd de l’Hôpital, 75013, Paris, France

    Tom Boeken, Eimad Shotar, Évelyne Cormier, Atika Talbi, Frédéric Clarençon & Kévin Premat

  2. Department of Rheumatology, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, Paris, France

    Déborah Puyraimond-Zemmour

  3. Department of Orthopedic Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, Paris, France

    Raphaël Bonaccorsi

  4. Department of Anesthesiology, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, Paris, France

    Jugurtha Mahtout & Mehdi Drir

  5. Sorbonne University, Paris, France

    Frédéric Clarençon

  6. GRC BioFast, Sorbonne University, Paris, France

    Frédéric Clarençon

Authors
  1. Tom Boeken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eimad Shotar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Évelyne Cormier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Déborah Puyraimond-Zemmour
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atika Talbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raphaël Bonaccorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jugurtha Mahtout
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mehdi Drir
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Frédéric Clarençon
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kévin Premat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kévin Premat.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Pr Frederic Clarencon.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because of the type of study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

Additional information

Publisher’s note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boeken, T., Shotar, E., Cormier, É. et al. The “Eiffel Tower” technique: novel long-axis sacroplasty under electromagnetic navigation assistance; feasibility and descriptive study. Eur Radiol 32, 7640–7646 (2022). https://doi.org/10.1007/s00330-022-08825-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-022-08825-0

Keywords

Search

Navigation