Ep. 456 Sacroplasty I: Principles and New Data in the Treatment of Sacral Insufficiency Fractures with Dr. Doug Beall

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