0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed

Name of the Procedure:

Percutaneous Sacral Augmentation (Sacroplasty), Unilateral Injection(s)

Summary

Percutaneous sacral augmentation, also known as sacroplasty, is a minimally invasive procedure used to stabilize and strengthen fractures or collapsed areas in the sacrum (the triangular bone at the base of the spine). Using imaging guidance, medical professionals inject bone cement into the affected area, sometimes employing a balloon or mechanical device to create space for the cement injection.

Purpose

The primary purpose of sacroplasty is to relieve pain and stabilize fractures in the sacrum, often caused by osteoporosis, trauma, or metastatic disease. The goal is to improve the patient's ability to move and enhance their quality of life by reducing pain and preventing further bone collapse.

Indications

• Persistent lower back or buttock pain due to sacral insufficiency fractures
• Sacral fractures resulting from osteoporosis or trauma
• Pain unresponsive to conservative treatments like pain medication and rest
• Metastatic disease leading to sacral bone weakening or fractures

Preparation

• Patients may be instructed to fast for a few hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted or paused.
• Pre-procedure assessments such as blood tests and imaging studies (e.g., MRI, CT scans) are often conducted to verify the site and extent of the fracture.

Procedure Description

1. The patient lies face down on a specialized table.
2. A local anesthetic or light sedation is administered for comfort.
3. Using imaging guidance (fluoroscopy or CT), a needle is inserted into the affected area of the sacrum.
4. A balloon or mechanical device may be employed to create a cavity within the bone.
5. Bone cement is injected through the needle into the created space to stabilize the fracture.
6. Once the cement hardens, the needles are removed, and the injection site is dressed.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Percutaneous sacral augmentation is usually performed in a hospital, outpatient clinic, or a specialized surgical center.

Personnel

• Interventional radiologist or spine specialist
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection at the injection site
• Bleeding or hematoma formation
• Cement leakage into surrounding tissues
• Nerve damage causing pain or numbness
• Allergic reactions to the anesthesia or cement material

Benefits

• Significant pain relief often realized within days
• Enhanced mobility and ability to perform daily activities
• Reduced need for pain medications
• Stabilization of the sacral fracture preventing further bone collapse

Recovery

• Patients are usually monitored for a short period before being discharged.
• Mild pain or soreness at the injection site is common and can be managed with over-the-counter pain medication.
• Most patients can resume normal activities within a few days, but strenuous activities should be avoided for a few weeks.
• Follow-up appointments are essential to monitor the healing process and ensure the effectiveness of the procedure.

Alternatives

• Conservative treatments such as pain medications, physical therapy, and rest
• Vertebroplasty or kyphoplasty if other areas of the spine are affected
• Surgery, although this is typically reserved for more severe cases or when other treatments have failed

Patient Experience

During the procedure, patients might feel the initial needle insertion, but discomfort is minimized with local anesthesia or light sedation. Post-procedure, patients might experience mild pain or soreness at the injection site, which usually subsides within a few days. Pain relief from the procedure is often rapid, significantly enhancing comfort and mobility. Pain management and comfort measures are readily available to ensure a smooth recovery.