All-fluoroscopic technique for sacral vertebroplasty.

BACKGROUND: Osteoporosis and other conditions that predispose to spinal compression fractures can also result in painful sacral insufficiency fractures. Recently percutaneous vertebroplasty has been applied to treat these fractures. Due to difficulty identifying the correct cannula depth into the sacrum under fluoroscopy alone, the procedure is typically performed using a combined fluoroscopic- and CT-guided technique. In patients who have undergone lumbo-sacral fusions with pedicle screws in place, the CT-guided image is degraded by metal artifact, making visualization of the cannula tip difficult. CASE REPORT: Described is a technique using fluoroscopic imaging for reliable cannula placement in a patient with a sacral insufficiency fracture and previous pedicle screw fixation.