Treatment for sacral insufficiency fractures: A systematic review

Area of Science:

• Orthopedic Surgery
• Spinal Fusion Complications
• Sacral Fractures

Background:

• Sacral insufficiency fractures are an uncommon but challenging complication following lumbosacral fusion.
• Diagnosis can be difficult due to nonspecific symptoms and inconclusive imaging.
• Treatment options range from conservative measures to surgical intervention.

Purpose of the Study:

• To systematically review the literature on treatment strategies for sacral insufficiency fractures after lumbosacral fusion.
• To provide insights for improving clinical diagnosis and management of these fractures.
• To aid clinicians in developing effective treatment plans for affected patients.

Main Methods:

• A systematic literature review was conducted using the PubMed database.
• Keywords included 'sacral insufficiency fracture treatment after lumbosacral fusion' and 'sacral insufficiency fracture after posterior spinal instrumentation'.
• Inclusion and exclusion criteria were applied to 32 identified publications, resulting in 17 articles for review.

Main Results:

• 65% of sacral insufficiency fractures were managed surgically, while 35% received non-operative treatment.
• Surgical revision, typically involving sacropelvic fixation, led to immediate symptom resolution in most cases.
• Five cases of failed non-operative management were successfully treated with revision surgery.

Conclusions:

• Non-operative management offers symptom resolution but with slower relief and a higher failure rate.
• Surgical intervention, particularly with sacropelvic fixation, provides rapid symptom relief and a low failure rate.
• Clinicians should maintain a high suspicion for sacral insufficiency fractures in patients with new-onset pain post-lumbosacral surgery and consider CT imaging.