Ivan Urits1, Vwaire Orhurhu2, Jessica Callan3, Nishita V Maganty3, Sara Pousti3, Thomas Simopoulos2, Cyrus Yazdi2, Rachel J Kaye4, Lauren K Eng5, Alan D Kaye4, Laxmaiah Manchikanti6, Omar Viswanath7,8,9. 1. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu. 2. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. 3. Department of Anesthesia, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. 4. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. 5. Tulane School of Medicine, New Orleans, LA, USA. 6. Pain Management Centers of America, Louisville, KY, USA. 7. Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA. 8. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA. 9. Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
Abstract
PURPOSE OF THE REVIEW: Sacral insufficiency fractures (SIF) are a common and often underdiagnosed source of low back pain. In patients with SIF, there is both a compromised sacroiliac joint and weakened sacrum, resulting in decreased resistance to torsional stress, leading to fracture. While conservative medical management is a safe option, minimally invasive intervention may provide improved short and long-term relief of low back pain in patients presenting with SIF. This comprehensive review is undertaken to provide an update to the current understanding of SIF with description of risk factors, clinical presentation, and management. RECENT FINDINGS: Sacroplasty is a minimally invasive procedure in which polymethylmethacrylate (PMMA) cement is inserted into bone to improve its structural integrity and alleviate symptoms. Balloon sacroplasty (BSP) has also been successful in alleviating pain with minimal cement leakage in SIF patients. Various other interventional techniques, including navigation-assisted screw fixation have been used to address SIF and have shown improvement in pain with minimal side effects. This review included various modalities of treatments available to manage SIF. This review shows that in comparison with nonsurgical management, sacroplasty has been shown to have greater pain reduction and improved mobility.
PURPOSE OF THE REVIEW: Sacral insufficiency fractures (SIF) are a common and often underdiagnosed source of low back pain. In patients with SIF, there is both a compromised sacroiliac joint and weakened sacrum, resulting in decreased resistance to torsional stress, leading to fracture. While conservative medical management is a safe option, minimally invasive intervention may provide improved short and long-term relief of low back pain in patients presenting with SIF. This comprehensive review is undertaken to provide an update to the current understanding of SIF with description of risk factors, clinical presentation, and management. RECENT FINDINGS: Sacroplasty is a minimally invasive procedure in which polymethylmethacrylate (PMMA) cement is inserted into bone to improve its structural integrity and alleviate symptoms. Balloon sacroplasty (BSP) has also been successful in alleviating pain with minimal cement leakage in SIFpatients. Various other interventional techniques, including navigation-assisted screw fixation have been used to address SIF and have shown improvement in pain with minimal side effects. This review included various modalities of treatments available to manage SIF. This review shows that in comparison with nonsurgical management, sacroplasty has been shown to have greater pain reduction and improved mobility.
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