Sacral vertebral augmentation: confirmation of fluoroscopic landmarks by open dissection

Area of Science:

• Orthopedics
• Interventional Radiology
• Biomedical Engineering

Background:

• Sacral insufficiency fractures are a common cause of spine pain in osteoporotic patients.
• Sacroplasty, using percutaneous polymethyl methacrylate (PMMA) cement, is a treatable option.
• Accurate cannula placement and cement deposition are crucial due to complex sacral anatomy.

Purpose of the Study:

• To determine precise fluoroscopic landmarks for cannula placement in sacroplasty.
• To evaluate the efficacy of vertebral augmentation devices for controlled cement delivery in sacral procedures.
• To confirm cement deposition within sacral cortical boundaries.

Main Methods:

• Utilized excised sacral cadaveric specimens with metal surface markers.
• Identified fluoroscopic landmarks for cannula placement via dorsal approach.
• Evaluated two vertebral augmentation devices (sacral balloon kyphoplasty and Arcuplasty) in cadaver specimens.
• Performed open dissection to visually confirm cement deposition and extravasation.

Main Results:

• Precise fluoroscopic landmarks were identified, defining a 'breach' area outside sacral cortical boundaries.
• Both evaluated devices (balloon kyphoplasty and Arcuplasty) demonstrated controlled PMMA cement deposition.
• Cement was confined within sacral cortical boundaries with no extravasation into the sacral foramen in balloon kyphoplasty.
• Arcuplasty device showed confined cement deposition within created osteotomies.

Conclusions:

• Established fluoroscopic landmarks facilitate accurate cannula placement for sacroplasty.
• Vertebral augmentation devices enhance control over PMMA cement deposition during sacral augmentation.
• These techniques improve the safety and precision of sacroplasty for sacral insufficiency fractures.