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):
pubmed.ncbi.nlm.nih.gov/7097924/
Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000):
pubmed.ncbi.nlm.nih.gov/11094...
Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019):
pubmed.ncbi.nlm.nih.gov/31587...
Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008):
pubmed.ncbi.nlm.nih.gov/17981...
Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017):
pubmed.ncbi.nlm.nih.gov/29149...
Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020):
www.thieme-connect.de/product...
An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023):
pubmed.ncbi.nlm.nih.gov/37207...
Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019):
​journals.lww.com/njcp/fulltex...
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