Sacroplasty is a minimally invasive medical procedure designed to treat fractures of the sacrum, the large, triangular bone at the base of the spine. This intervention provides substantial pain relief by stabilizing the fractured bone. The procedure reinforces the sacrum, which bears significant weight, by creating an internal cast that restores structural support to the weakened bone.
Candidates for Sacroplasty
Ideal candidates for sacroplasty suffer from sacral insufficiency fractures (SIFs), a type of stress fracture occurring in weakened bone. These fractures are often a consequence of osteoporosis, a disease that diminishes bone density and makes bones fragile. Patients with SIFs experience intense lower back, buttock, or groin pain that is aggravated by standing or walking. This pain frequently fails to respond to conservative treatments such as bed rest, bracing, or pain medications.
Beyond osteoporosis, other conditions can lead to the bone weakness that causes these fractures. Long-term use of steroid medications or a history of radiation therapy to the pelvic region can compromise sacral bone integrity. The procedure is particularly beneficial for those who cannot endure extended periods of immobility or who need a faster return to daily activities.
Sacroplasty is also a treatment option for individuals with painful sacral fractures caused by metastatic cancer. When cancer spreads to the sacrum, it can erode the bone and cause structural collapse and severe pain. In these cases, sacroplasty can effectively stabilize the sacrum and manage pain, improving the patient’s quality of life.
The Sacroplasty Procedure
The sacroplasty procedure begins with detailed medical imaging, such as a CT or MRI scan, to precisely locate the fracture and map out the approach. It is performed while the patient is under local anesthesia with conscious sedation, though general anesthesia may be used. The patient is positioned lying face down, and the skin over the sacrum is sterilized to prevent infection.
Using real-time X-ray imaging called fluoroscopy or CT guidance, the physician makes a small incision and guides one or two specialized hollow needles, known as trocars, into the fracture. This imaging technology allows for precise placement of the needles directly into the fracture lines, avoiding surrounding structures.
Once the needles are correctly positioned, a medical-grade bone cement called polymethylmethacrylate (PMMA) is slowly injected into the fractured area. This acrylic-based cement fills the cracks and voids in the weakened bone. The cement hardens within minutes, creating an internal cast that provides immediate stability. The needles are then withdrawn, and the small incision is closed.
Recovery and Expected Outcomes
Following the procedure, patients are monitored in a recovery area for a few hours. During this time, medical staff monitor vital signs to ensure no immediate complications arise. Patients are often advised to lie flat for a period to allow the bone cement to fully cure and set properly for maximum stability.
One of the primary benefits of sacroplasty is the rapid pain relief many individuals experience, often within hours or days of the procedure. This allows for a swift improvement in quality of life. Because the procedure is minimally invasive, it requires only a short hospital stay, with many patients being discharged the same day.
The recovery timeline allows for a gradual return to normal life. Patients can resume light activities within a week, though strenuous activities should be avoided for several weeks as instructed by a doctor. Physical therapy may be referred to help rebuild strength, flexibility, and mobility. For appropriately selected patients, sacroplasty has a high rate of success in reducing pain.
Potential Risks and Complications
While sacroplasty is a safe procedure, it carries some potential risks. The most common complication is cement leakage, also known as extravasation, where the cement seeps outside the targeted fracture site. If the cement leaks near a nerve root, it can cause irritation or compression, leading to sciatica-like pain that radiates down the leg.
A rarer but more serious risk is the leakage of cement into a blood vessel. If this occurs, the cement can travel through the bloodstream to the lungs, causing a pulmonary embolism, which is a medical emergency. Other complications include bleeding, infection at the injection site, or an adverse reaction to the anesthesia.
In some cases, patients may experience incomplete pain relief or, in rare instances, a worsening of their pain. The success of the procedure depends on factors like the precise nature of the fracture and the experience of the physician. A thorough discussion with a healthcare provider is necessary to weigh the benefits against these potential risks.