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Computer Assisted Percutaneous Placement of Augmented Iliosacral Screws: A Reasonable Alternative to Sacroplasty

Study Design. A technical report of fluoroscopy guided placement of augmented iliosacral screws in osteoporotic insufficiency fractures of the sacrum. Objective. To describe a combined approach of navigated iliosacral screw placement and screw augmentation as an option for osteosynthesis of sacral insufficiency fractures in the elderly. Summary of Background Data. The incidence of sacral insufficiency fractures is increasing. Outcome of conservative treatment is inconsistent. Recently sacroplasty is propagated as an interventional therapy but the long-term outcome is still unknown. Evidence from finite element models suggests that stabilization of the sacrum achieved by sacroplasty is insufficient to restore the weight bearing capacity of the sacrum permanently. Methods. We suggest a minimally invasive fluoroscopically navigated iliosacral screw osteosynthesis with cement augmentation of the screws for treatment of insufficiency fractures of the sacrum. Results. The procedure, especially fluoroscopic visualization and navigation of the osteoporotic sacrum is technically feasible. A total radiograph time of 7,4 minutes, including image acquisition for navigation and fluoroscopic control of cement injection, is acceptable and can be expected to be significantly reduced with repeated applications of the procedure. The patient presented in the report was discharged to rehabilitation soon after the operation. An assistive device (delta wheel) is only needed for longer walking distances. Pain was reduced drastically immediately after surgery. Conclusion. In general, fractures are treated by reduction and fixation to restore the biomechanical function of the injured bone. These principles should be applied to elderly patients with osteoporotic fractures as well. The technique reported here is adapted to the special demands of the elderly patient, i.e., minimally invasive, support of the weakened bone by cement augmentation, bone protective screw positioning and safety due to navigation support.