Skip to main content

Treatment Options for Sacral Insufficiency Fractures

  • Chapter
  • First Online:
Minimally Invasive Spine Intervention
  • 340 Accesses

Abstract

For many years, sacral insufficiency fracture (SIF) was a poorly known and frequently undiagnosed pathology. In recent years, much research has been done and published on SIF. This chapter provides an overview of the anatomy of the os sacrum including embryology. The pathophysiology and biomechanics of SIF are discussed. The possibilities of diagnostics are shown. The conservative and operative therapy is presented. In detail, the advantages and disadvantages of sacroplasty/balloon sacroplasty/radiofrequency sacroplasty, transiliosacral screw fixation, transsacral positioning rod, ilioiliac internal fixator with transiliosacral screw fixation, and lumbopelvic stabilization are discussed.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Andresen R et al (2017) 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 26(12):3235–3240

    Article  PubMed  Google Scholar 

  • Cabarrus MC et al (2008) MRI and CT of insufficiency fractures of the pelvis and the proximal femur. AJR Am J Roentgenol 191(4):995–1001

    Article  PubMed  Google Scholar 

  • Cheng JS, Song JK (2005) Anatomy of the sacrum. Neurosurg Focus 15(2):E3

    Google Scholar 

  • Fujii M et al (2005) Honda sign and variants in patients suspected of having a sacral insufficiency fracture. Clin Nucl Med 30(3):165–169

    Article  PubMed  Google Scholar 

  • Gotis-Graham I et al (1994) Sacral insufficiency fractures in the elderly. J Bone Joint Surg Br 76(6):882–886

    Article  CAS  PubMed  Google Scholar 

  • Grasland A et al (1996) Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med 156(6):668–674

    Article  CAS  PubMed  Google Scholar 

  • Gruneweller N et al (2017) Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model. J Orthop Res 35(7):1485–1493

    Article  PubMed  Google Scholar 

  • Höch A et al (2017) Biomechanical analysis of stiffness and fracture displacement after using PMMA-augmented sacroiliac screw fixation for sacrum fractures. Biomed Tech (Berl) 62(4):421–428

    Article  PubMed  Google Scholar 

  • Hohenberger G (2017) Teriparatide as a therapy approach in sacral insufficiency fractures. Unfallchirurg 120(11):1000–1003

    Article  CAS  PubMed  Google Scholar 

  • Kannus P et al (2000) Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970-1997 and alarming projections for the new millennium. Osteoporos Int 11(5):443–448

    Article  CAS  PubMed  Google Scholar 

  • Kortman K et al (2013) Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions. J Neurointerv Surg 5(5):461–466

    Article  PubMed  Google Scholar 

  • Lourie H (1982) Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly. JAMA 248(6):715–717

    Article  CAS  PubMed  Google Scholar 

  • Lyders EM et al (2010) Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol 31(2):201–210

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Matta JM, Saucedo T (1989) Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 242:83–97

    Article  Google Scholar 

  • Mendel T et al (2013) The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation. Injury 44(12):1773–1779

    Article  CAS  PubMed  Google Scholar 

  • Osterhoff G et al (2016) Cement augmentation in sacroiliac screw fixation offers modest biomechanical advantages in a cadaver model. Clin Orthop Relat Res 474(11):2522–2530

    Article  PubMed  PubMed Central  Google Scholar 

  • Peretz AM, Hipp JA, Heggeness MH (1998) The internal bony architecture of the sacrum. Spine (Phila Pa 1976) 23(9):971–974

    Article  CAS  PubMed  Google Scholar 

  • Prokop A, Andresen R, Chmielnicki M (2016) Balloonsacroplasty: C-arm or CT controlled application? Experience with 46 patients. Unfallchirurg 119(11):929–935

    Article  CAS  PubMed  Google Scholar 

  • Richards AM et al (2010) Bone density and cortical thickness in normal, osteopenic, and osteoporotic sacra. J Osteoporos 2010:504078. https://doi.org/10.4061/2010/504078

    Article  PubMed  PubMed Central  Google Scholar 

  • Song W, Zhou D, He Y (2016) The biomechanical advantages of bilateral lumbo-iliac fixation in unilateral comminuted sacral fractures without sacroiliac screw safe channel: a finite element analysis. Medicine (Baltimore) 95(40):e5026

    Article  PubMed  Google Scholar 

  • Taillandier J et al (2003) Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine 70(4):287–289

    Article  PubMed  Google Scholar 

  • Talmadge J et al (2014) Clinical impact of sacroplasty on patient mobility. J Vasc Interv Radiol 25(6):911–915

    Article  PubMed  Google Scholar 

  • Thakkar SC et al (2017) 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology. Int J Comput Assist Radiol Surg 12(1):69–76

    Article  PubMed  Google Scholar 

  • Wagner D et al (2017) Critical dimensions of trans-sacral corridors assessed by 3D CT models: relevance for implant positioning in fractures of the sacrum. J Orthop Res 35(11):2577–2584

    Article  PubMed  Google Scholar 

  • Weber M, Hasler P, Gerber H (1993) Insufficiency fractures of the sacrum. Twenty cases and review of the literature. Spine (Phila Pa 1976) 18(16):2507–2512

    Article  CAS  PubMed  Google Scholar 

  • West SG et al (1994) Sacral insufficiency fractures in rheumatoid arthritis. Spine (Phila Pa 1976) 19(18):2117–2121

    Article  CAS  PubMed  Google Scholar 

  • Yoo JI et al (2017) Teriparatide treatment in elderly patients with sacral insufficiency fracture. J Clin Endocrinol Metab 102(2):560–565

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Hölzl .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer-Verlag GmbH Germany, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hölzl, A. (2023). Treatment Options for Sacral Insufficiency Fractures. In: Jerosch, J. (eds) Minimally Invasive Spine Intervention. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-63814-9_29

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-63814-9_29

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-63813-2

  • Online ISBN: 978-3-662-63814-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics