Vertebroplasty of the first sacral vertebra

Area of Science:

• Orthopedics
• Interventional Radiology
• Spinal Surgery

Background:

• Sacral insufficiency fractures are challenging to treat, particularly involving the S1 vertebral body.
• Current techniques struggle with accurate central S1 access for cement delivery.
• The S1 vertebral body is a common site for these fractures but lacks reliable percutaneous access methods.

Purpose of the Study:

• To describe a novel percutaneous technique for accessing and treating the central S1 vertebral body in sacral insufficiency fractures.
• To introduce the use of a curved nitinol needle for improved cement deposition in the S1 vertebral body.
• To evaluate the safety and accuracy of this new approach in cadaver models.

Main Methods:

• Development of a transpedicular cannula placement technique into the S1 vertebral body in cadaver models.
• Utilizing a curved nitinol needle (AVAflex) through the cannula for central S1 access.
• Delivery of poly(methyl methacrylate) (PMMA) cement via the nitinol needle under fluoroscopic guidance.
• Employing extreme caudad angulation of the fluoroscope for enhanced visualization.

Main Results:

• The described technique enables accurate percutaneous cannula placement into the S1 vertebral body.
• The AVAflex needle facilitates controlled deposition and good distribution of PMMA cement in the central S1 body.
• Fluoroscopic monitoring with extreme caudad angulation aids in safe cement delivery and avoids extravasation.
• Simultaneous sacroplasty of lateral sacral elements is feasible.

Conclusions:

• The curved nitinol needle technique offers a safe and accurate method for addressing sacral insufficiency fractures involving the S1 vertebral body.
• This approach expands treatment options for sacral insufficiency fractures, specifically targeting the S1 component.
• Sacroplasty for sacral insufficiency fractures, including the S1 vertebral body, is an evolving field with promising new techniques.