In this episode of the BackTable MSK Podcast, Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty.

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SYNPOSIS

Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI.

We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations.

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TIMESTAMPS

00:00 - Introduction

03:01 - Sacral Fractures and Sacroplasty

15:17 - Treatment Options for Sacral Fractures

17:34 - Consequences of Untreated Sacral Fractures

28:32 - Sacroplasty Registry and Current Research

38:08 - Imaging Modalities: CT vs. Fluoroscopy

40:49 - Complications of Sacroplasty: Extravasation

43:21 - Bone Quality and Fracture Healing

45:42 - Growing Awareness of Sacral Fractures and Treatment Options

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RESOURCES

Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982):

https://pubmed.ncbi.nlm.nih.gov/7097924/

Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000):

https://pubmed.ncbi.nlm.nih.gov/11094996/

Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019):

https://pubmed.ncbi.nlm.nih.gov/31587952/

Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008):

https://pubmed.ncbi.nlm.nih.gov/17981097/

Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017):

https://pubmed.ncbi.nlm.nih.gov/29149151/

Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020):

https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226

An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023):

https://pubmed.ncbi.nlm.nih.gov/37207812/

Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019):

​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx