CT-guided sacroplasty for the treatment of zone II sacral insufficiency fractures

Sacral insufficiency fractures are a relatively common cause of low back pain in the elderly. Osteoporosis is the leading cause, most commonly affecting elderly women. Other causes include chronic steroid use, radiation exposure, and arthritis. Patients typically present with severe low back pain, which in some cases results in immobility with its associated complications. However, sacral insufficiency fractures are commonly underdiagnosed due to difficulty in visualizing the fracture line on radiographs. However, other imaging methods, such as computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy, can accurately diagnose this condition. Denis and co-workers reported a classification system for sacral fracture patterns, which describes three zones: zone I (alar zone) fractures extend through the ala without any extension into the foramina or the central sacral canal; zone II (foraminal zone) fractures involve one or several foramina; and zone III (central zone) fractures primarily involve the central sacral canal. Although most sacral insufficiency fractures affect the sacral ala, the fracture line may extend to involve the sacral foramina. A potential complication of sacroplasty is the extrusion of cement into the sacral foramina that could lead to injury of the sacral nerves or cement migration into the spinal canal. Therefore, a fracture line extending into the sacral foramen must be treated with caution and it has been suggested that only zone I fractures should be treated with