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Updated: Aug 29, 2025

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Staged Cement Injections for Massive Sacral Hemangioma.

Sarah E Leonard, Charles C Edwards

    Orthopedics
    |September 6, 2022
    PubMed
    Summary

    A 57-year-old man with chronic mid-sacral pain had a large hemangioma in S1. Conservative treatments failed, so doctors used staged cement injections. The first injection in the right side partially eased pain. After a 2-month break, a second injection in the left side provided full relief. No complications occurred. At 5 years, the patient remained pain-free. This case suggests staged cement augmentation is a safe and effective treatment for massive sacral hemangiomas.

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    Area of Science:

    • Interventional radiology techniques in orthopedic care
    • Spinal tumor management within musculoskeletal medicine
    • Pain stabilization strategies in orthopedic surgery

    Background:

    Chronic sacral pain remains a diagnostic and therapeutic challenge. Most vertebral hemangiomas do not cause symptoms. But when they do, pain management becomes difficult. Conservative treatments often fail in large lesions. Structural compromise may lead to microfractures. No prior work had resolved how to safely treat massive sacral hemangiomas. Traditional cement augmentation risks embolic complications. This gap motivated exploring staged approaches. The need for safer stabilization methods is clear.

    Purpose Of The Study:

    This case aimed to evaluate staged cement augmentation for a large sacral hemangioma. The patient had persistent mid-sacral pain unresponsive to conservative care. Imaging showed a massive lytic defect in S1. The goal was to stabilize the proximal sacrum safely. The concern was cement embolization risks. A staged bilateral approach was planned. The first injection targeted the right side. The second injection followed after a recovery period.

    Keywords:
    sacral hemangioma treatmentbone cement augmentationspinal tumor managementinterventional radiology techniques

    Frequently Asked Questions

    The authors propose that pain relief comes from stabilizing the compromised proximal sacrum. Cement injections reduce microfracture-related pain.

    To reduce cement embolic risks, the authors chose a staged approach. A 2-month interval allowed pulmonary recovery between procedures.

    The patient reported no recurrence of mid-sacral pain at 5 years. This suggests long-term structural stabilization and pain relief.

    MRI revealed the hemangioma's extent, guiding injection placement. It confirmed the massive lytic defect involving S1.

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    Main Methods:

    The patient underwent two separate cement augmentation procedures. The first injection delivered 12 mL of bone cement to the right proximal sacrum. A 2-month interval was allowed for pulmonary recovery. The second injection placed 8 mL in the left proximal sacrum. Magnetic resonance imaging confirmed the hemangioma's extent. The staged approach aimed to reduce embolic risks. Pain levels were monitored after each procedure. No complications were reported during either injection.

    Main Results:

    The first injection provided partial pain relief. The second injection achieved excellent pain relief. No cement embolic complications occurred in either stage. The patient remained pain-free at 5-year follow-up. No recurrence of mid-sacral pain was reported. Pain levels decreased significantly after each procedure. The staged approach allowed safe cement delivery. The authors suggest this is the first successful case of its kind.

    Conclusions:

    Staged cement augmentation proved effective for this massive sacral hemangioma. The bilateral approach reduced embolic risks. Pain relief was achieved with two separate injections. No complications were observed during or after treatment. The 5-year follow-up supports long-term success. This method may offer a new treatment option. The authors propose that staged augmentation is a viable strategy. Further case studies could confirm broader applicability.

    The first injection used 12 mL in the right proximal sacrum. The second used 8 mL in the left proximal sacrum.

    The authors suggest this is the first successful case of staged cement augmentation for a sacral hemangioma. They propose it as a viable treatment strategy.