Percutaneous sacroplasty under fluoroscopic guidance combined with epidurogram for sacral insufficiency fracture resulting from metastatic tumor and osteoporosis

Sacral insufficiency fracture resulting from a metastatic tumor or an osteoporotic fracture causes severe low back pain and radiating pain mass effect on neural foramen and chemical irritants. Percutaneous sacroplasty is one of the effective treatment modalities for sacral insufficiency fracture and its pain. Because of the structural complexity of the sacrum, obtaining an epidurogram of the S1 and S2 nerve roots before the start of the procedure can be helpful to avoid nerve injury. We present 2 successful cases of percutaneous sacroplasty performed under fluoroscopic guidance. A 65-year-old man with sacral metastasis from stomach cancer and a 52-year-old man with sacral insufficiency fracture were suffering from severe buttock pain and radiating pain. After epidurography of the S1 and S2 nerve roots with steroid and contrast dye, percutaneous sacroplasty with fluoroscopy on the S1 or S2 body and alae was performed on both patients. There was no cement leakage or any other major complications. Both patients experienced significant reduction in pain.