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Yang YC, Hsieh MH, Chien JT, Liu KC, Yang CC. Teriparatide treatment shows faster healing than sacroplasty for postmenopausal women with sacral insufficiency fracture. Osteoporos Sarcopenia 2023; 9:27-31. [PMID: 37082353 PMCID: PMC10111959 DOI: 10.1016/j.afos.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/06/2023] [Accepted: 02/03/2023] [Indexed: 04/22/2023] Open
Abstract
Objectives Sacral insufficiency fracture (SIF) is not an uncommon osteoporosis fracture among the elderly. Aside from traditional treatments, sacroplasty and teriparatide (TPTD) injection have been introduced. This report aims to compare the effects of sacroplasty and teriparatide on clinical outcomes of SIF. Methods Thirty-one elderly patients with SIF were enrolled in this retrospective observational study. Four male patients were excluded. Fourteen patients who received TPTD for 6 months were classified into the TPTD group (TT), and 13 who underwent sacroplasty were classified into the sacroplasty group (SS). All patients in both groups were instructed to take calcium and vitamin D supplements daily. Their symptoms and signs, visual analog score (VAS), Oswestry disability index (ODI), and radiographic studies were retrospectively reviewed. Results The TT group showed significantly lower VAS than SS group after 3 (P < 0.001) and 6 months of treatment (P < 0.001). The TT group also has significant lower ODI than SS group after 1 (P = 0.010), 3 (P = 0.005) and 6 months (P < 0.001) of treatment. Upon generalized estimating equations (GEE) analysis, the TT group showed significantly more reduction in both VAS and ODI compared to the SS group at 1 month (P = 0.022, P = 0.001), 3 months (P < 0.001, P < 0.001), and 6 months (P < 0.001, P < 0.001) post-treatment. Conclusions Postmenoposal woman with SIF who received TPTD healed better than those who underwent sacroplasty after 1 month treatment.
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Affiliation(s)
- Yao-Chun Yang
- National Taiwan University, School of Medicine, Taiwan
| | - Min-Hong Hsieh
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
- School of Medicine, Tzu Chi University, 97071, Taiwan
| | - Jui-Teng Chien
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
- School of Medicine, Tzu Chi University, 97071, Taiwan
| | - Keng-Chang Liu
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
| | - Chang-Chen Yang
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
- School of Medicine, Tzu Chi University, 97071, Taiwan
- Corresponding author. Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 62247, Taiwan.
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Caetano AP, Mascarenhas VV, Machado PM. Axial Spondyloarthritis: Mimics and Pitfalls of Imaging Assessment. Front Med (Lausanne) 2021; 8:658538. [PMID: 33968964 PMCID: PMC8100693 DOI: 10.3389/fmed.2021.658538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/11/2021] [Indexed: 01/15/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that predominantly involves the axial skeleton. Imaging findings of axSpA can be divided into active changes, which include bone marrow edema, synovitis, enthesitis, capsulitis, and intra-articular effusion, and structural changes, which include erosions, sclerosis, bone fatty infiltration, fat deposition in an erosion cavity, and bone bridging or ankylosis. The ability to distinguish between imaging lesions suggestive of axSpA and artifacts or lesions suggestive of other disorders is critical for the accurate diagnosis of axSpA. Diagnosis may be challenging, particularly in early-stage disease and magnetic resonance imaging (MRI) plays a key role in the detection of subtle or inflammatory changes. MRI also allows the detection of structural changes in the subchondral bone marrow that are not visible on conventional radiography and is of prognostic and monitoring value. However, bone structural changes are more accurately depicted using computed tomography. Conventional radiography, on the other hand, has limitations, but it is easily accessible and may provide insight on gross changes as well as rule out other pathological features of the axial skeleton. This review outlines the imaging evaluation of axSpA with a focus on imaging mimics and potential pitfalls when assessing the axial skeleton.
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Affiliation(s)
- António Proença Caetano
- Radiology Department, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Grupo Luz Saúde, Radiology Department, Imaging Center, Hospital da Luz, Lisbon, Portugal.,EpiDoC Unit, Chronic Diseases Research Centre, NOVA Medical School, Lisbon, Portugal
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom.,Department of Rheumatology, London North West University Healthcare National Health Service Trust, London, United Kingdom
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Affiliation(s)
- Aleksander Mika
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Park JW, Park SM, Lee HJ, Lee CK, Chang BS, Kim H. Mortality following benign sacral insufficiency fracture and associated risk factors. Arch Osteoporos 2017; 12:100. [PMID: 29124468 DOI: 10.1007/s11657-017-0395-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/25/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study demonstrated increased mortality following sacral insufficiency fractures as with other major osteoporotic fractures. The 6-month mortality rate was 9.8%, the 1-year mortality rate was 17.5%, and the 3-year mortality rate was 25.5%. Sex- and age-adjusted standardized mortality ratio increased after fractures. INTRODUCTION There are no data about mortality after sacral insufficiency fractures. The purposes of this study were to investigate the mortality rate among sacral insufficiency fracture patients and to identify risk factors associated with mortality. METHODS This is a retrospective cohort study of patients diagnosed with sacral insufficiency fracture via radiological exam in a single institute from 2001 to 2014, excluding patients with pathological sacral fracture due to metastasis or primary tumor. Mortality and its predisposing factors were analyzed based on a review of electronic medical records and mortality data provided by the Korean Statistical Information Service. Kaplan-Meier survival analysis and Cox regression analysis were used for statistical analysis. RESULTS A total of 325 patients were included (275 women and 50 men). The mean age at the time of diagnosis was 69.4 years. One hundred and forty patients (43.1%) had a history of malignancy, and 71 patients (21.8%) had undergone pelvic radiation therapy before fracture diagnosis. Twenty-one patients (6.5%) underwent sacroplasty, and the others underwent conservative management after fracture diagnosis. The mean follow-up was 51.5 months, and a total of 101 patients died at the final follow-up. The 6-month mortality rate was 9.8%, the 1-year mortality rate was 17.5%, and the 3-year mortality rate was 25.5%. Sex- and age-adjusted standardized mortality ratio (SMR) increased after fractures. The overall SMR is 8.9 at 3 months decreasing to 4.5 at 2 years. Multivariable Cox regression analysis showed that significant factors associated with increased mortality were male gender, malignancy history, lumbosacral fusion with distal fusion level S1, stroke history, low total femur bone mineral density score, and low body mass index. CONCLUSIONS Like other types of osteoporotic fractures, sacral insufficiency fractures are associated with increased mortality.
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Affiliation(s)
- Jae-Woo Park
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, South Korea
| | - Sang-Min Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, South Korea
| | - Hui Jong Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Choon-Ki Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Bong-Soon Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyoungmin Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Andresen R, Radmer S, Andresen JR, Schober HC. 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. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:3235-3240. [DOI: 10.1007/s00586-016-4935-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 11/26/2016] [Accepted: 12/25/2016] [Indexed: 01/01/2023]
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Gupta AC, Chandra RV, Yoo AJ, Leslie-Mazwi TM, Bell DL, Mehta BP, Vanderboom TL, Rabinov JD, Larvie M, Hirsch JA. Safety and effectiveness of sacroplasty: a large single-center experience. AJNR Am J Neuroradiol 2014; 35:2202-6. [PMID: 25012675 DOI: 10.3174/ajnr.a4027] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Sacral insufficiency fractures are a common cause of severe low back pain and immobilization in patients with osteoporosis or cancer. Current practice guideline recommendations range from analgesia and physical therapy to resection with surgical fixation. We sought to assess the safety and effectiveness of sacroplasty, an emerging minimally invasive treatment. MATERIALS AND METHODS We performed a retrospective review of institutional databases for percutaneous sacroplasty performed between January 2004 and September 2013. Demographic and procedural data and pre- and posttreatment Visual Analog Scale, Functional Mobility Scale, and Analgesic Scale scores were reviewed. Overall response was rated by using a 4-point scale (1, complete resolution of pain; 2, improvement of pain; 3, no change; 4, worsened pain) assessed at short-term follow-up. RESULTS Fifty-three patients were included; most (83%) were female. Fracture etiology was cancer-related (55%), osteoporotic insufficiency (30%), and minor trauma (15%). No major complication or procedure-related morbidity occurred. There were statistically significant decreases in the Visual Analog Scale (P < .001), Functional Mobility Scale (P < .001), and Analgesic Scale scores (P < .01) in 27 patients with recorded data: pretreatment Visual Analog Scale (median [interquartile range], 9.0 [8.0-10.0]); Functional Mobility Scale, 3.0 (2.0-3.0); and Analgesic Scale scores, 3.0 (3.0-4.0) were reduced to 3.0 (0.0-5.8), 1.0 (0.25-2.8), and 3.0 (2.0-3.8) posttreatment. When we used the overall 4-point score at a mean of 27 days, 93% (n = 45) reported complete resolution or improvement in overall pain. CONCLUSIONS In this single-center cohort, sacroplasty was a safe and effective procedure. There were significant short-term gains in pain relief, increased mobility, and decreased dependence on pain medication.
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Affiliation(s)
- A C Gupta
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - R V Chandra
- Department of Radiology (R.V.C.), Monash Health, and Department of Surgery, Monash University, Melbourne, Australia
| | - A J Yoo
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - T M Leslie-Mazwi
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D L Bell
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - B P Mehta
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - T L Vanderboom
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - J D Rabinov
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Larvie
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - J A Hirsch
- From the Department of Radiology (A.C.G., A.J.Y., T.M.L.-M., D.L.B., B.P.M., T.L.V., J.D.R., M.L., J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Pereira LP, Clarençon F, Cormier É, Rose M, Jean B, Le Jean L, Chiras J. Safety and effectiveness of percutaneous sacroplasty: a single-centre experience in 58 consecutive patients with tumours or osteoporotic insufficient fractures treated under fluoroscopic guidance. Eur Radiol 2013; 23:2764-72. [DOI: 10.1007/s00330-013-2881-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/21/2013] [Accepted: 04/10/2013] [Indexed: 12/13/2022]
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Barber SM, Livingston AD, Cech DA. Sacral radiculopathy due to cement leakage from percutaneous sacroplasty, successfully treated with surgical decompression. J Neurosurg Spine 2013; 18:524-8. [DOI: 10.3171/2013.2.spine12497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Percutaneous sacroplasty is a procedure adapted from vertebroplasty, which is designed to ameliorate the painful morbidity associated with sacral insufficiency fractures without the invasiveness of open surgery. Early estimates of efficacy, according to several case reports and small series, appear promising, but the procedure is not without risk. Several cases of radiculopathy due to nerve root compression by extravasated polymethylmethacrylate (PMMA) have been reported. The authors present a case of radiculopathy caused by cement leakage from sacroplasty, treated with surgical decompression of the compromised nerve root. The patient presented with left S-1 radiculopathy and was found on CT to have a left S-1 nerve root completely encased in PMMA over a portion of its length. The patient underwent sacral laminectomy with the removal of PMMA and experienced pain relief and the return of function postoperatively. Surgical removal of PMMA extravasated during sacroplasty is feasible and should be considered when nerve root compression or canal stenosis causes pain or neurological deficit refractory to conservative therapy.
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Rommens PM, Wagner D, Hofmann A. Surgical management of osteoporotic pelvic fractures: a new challenge. Eur J Trauma Emerg Surg 2012; 38:499-509. [PMID: 23162670 PMCID: PMC3495273 DOI: 10.1007/s00068-012-0224-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 08/24/2012] [Indexed: 11/24/2022]
Abstract
The number and variety of osteoporotic fractures of the pelvis are rapidly growing around the world. Such fractures are the result of low-impact trauma. The patients have no signs of hemodynamic instability and do not require urgent stabilization. The clinical picture is dominated by immobilizing pain in the pelvic region. Fractures may be located in both the ventral and the dorsal pelvic ring. The current well-established classification of pelvic ring lesions in younger adults does not fully reflect the criteria for osteoporotic and insufficiency fractures of the pelvic ring. Most osteoporotic fractures are minimally displaced and do not require surgical therapy. However, in some patients, an insidious progress of bone damage leads to complex displacement and instability. Therefore, vertical sacral ala fractures, fracture dislocations of the sacroiliac joint, and spinopelvic dissociations are best treated with operative stabilization. Angular stable bridge plating, the insertion of a transsacral positioning bar, and iliolumbar fixation are operative techniques that have been adapted to the low bone mineral density of the pelvic ring and the high forces acting on it.
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Affiliation(s)
- P M Rommens
- Department of Trauma Surgery, Center of Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany
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Kortman K, Ortiz O, Miller T, Brook A, Tutton S, Mathis J, Georgy B. Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions. J Neurointerv Surg 2012; 5:461-6. [DOI: 10.1136/neurintsurg-2012-010347] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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