Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis

Clinical Question
What is the safety and efficacy of sacroplasty for the treatment of osteoporotic and malignant sacral fractures?

Take-Away Point
Sarcoplasty is a safe procedure for treating painful sacral insufficiency fractures resulting from osteoporosis or metastasis and reduces patient pain scores up to a year post-procedure.

Reference
Chandra, Vishnu et al. Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis. Journal of Vascular and Interventional Radiology, Volume 30, Issue 11, 1845 - 1854.

Click here for abstract

Study Design
Systematic review and meta-analysis

Funding Source
Self-funded or unfunded

Setting
Multi-center

Summary

Sacral insufficiency fractures (SIFs) are a common and growing cause of lower back pain in the elderly population and are often a result of osteoporosis or metastatic spread to the sacrum. Standard therapies consist of conservative management with rest, analgesia, and physical therapy. They are associated with deconditioning, deep venous thrombosis/pulmonary embolism, and psychiatric disease. Sarcoplasty is an evolving minimally-invasive therapy aimed at reducing patient pain due to SIF and allowing improved quality of life and function.

In this meta-analysis and systematic review, 19 retrospective and prospective case series were analyzed for a pooled cohort of 861 patients undergoing 867 procedures. Patients all had sacral insufficiency fractures, with 664 secondary to osteoporosis, 67 to malignancy, and 30 non-specified. Included studies measured pre- and post-procedural pain via the visual analog scale (VAS) as reported by the patient prior to and up to 18 months after sarcoplasty. Complications of the procedure and follow-up treatment were also measured.

VAS scores at pre-procedure, 24–48 hours, 6 months, and 12 months yielded cumulative pain scores of 8.35 ± 0.14 (n=861), 2.70 ± 0.26 (n=749), 2.26 ± 0.24 (n=352), and 2.01 ± 0.34 (n=357), respectively. There was no significant difference in mean pain scores between patients with osteoporotic SIFs and patients with SIF secondary to metastatic disease at any time point. Clinical success (defined as patient-reported pain relief) occurred in 623 of 651 (95.7%) of cases where post-procedural clinical status was evaluated.

Cement leakage was reported in 19 of 867 cases (2.2%), which resulted in clinical symptoms in 5 patients. 3 of these required surgical decompression while 2 were treated successfully with conservative management. No other complications, including infection, bleeding, or pulmonary embolism were reported.

Commentary

In this meta-analysis and systematic review, sarcoplasty was shown to be safe and effective at relieving patient pain up to a year from the procedure. Other outcomes, such as patient functional status, mobility, satisfaction, or use of pain medications (such as opioids) were not measured. Future investigations should compare sarcoplasty versus sham and conservative therapies in the form of randomized controlled trials, while future retrospective studies should measure the long-term efficacy and safety of sarcoplasty as well as the use of opioids and patient functional status.
 
Post Author
Jared Edwards
4th Year Medical Student
Oregon Health & Science University School of Medicine, Portland, OR