Health Technology Brief

supporting sound, evidence-based decision making

Percutaneous Sacroplasty for Treatment of Sacral Insufficiency Fractures

November 12, 2018

Health Problem: Sacral insufficiency fractures (SIFs) are fragility fractures of the sacrum that destabilize the pelvis and cause debilitating low back pain. The overall incidence of SIF is difficult to determine; however, one estimate suggests that 19% of patients aged > 70 years who underwent bone scan had an SIF.

Technology Description: Percutaneous sacroplasty involves the injection of acrylic (polymethylmethacrylate) or bioceramic bone cement into the SIF to restore the mechanical integrity and stability of the sacrum and thereby relieve pain and restore mobility.

Controversy: A rapid and effective treatment for SIFs would prevent complications associated with prolonged bed rest and reduce or eliminate the need for narcotic medication use. Percutaneous sacroplasty is a minimally invasive procedure that quickly strengthens the fractured sacrum, thus decreasing pain and enabling immediate mobilization. However, nonbiodegradable polymethylmethacrylate cement does not permit normal osseous healing or remodeling. It has yet to be determined whether sacroplasty is more effective than conservative measures for the treatment of SIF.

Key Questions:

  • Is sacroplasty effective in treating SIFs?
  • How does sacroplasty compare with other treatments for SIFs?
  • Is sacroplasty safe?
  • Have definitive patient selection criteria been identified for sacroplasty for the treatment of SIFs?