0201T Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed

Name of the Procedure:

Percutaneous Sacral Augmentation (Sacroplasty), Bilateral Injections with Balloon or Mechanical Device

Summary

Percutaneous sacral augmentation, commonly referred to as sacroplasty, is a minimally invasive procedure involving the injection of medical-grade bone cement into the sacrum. This treatment can include the use of a balloon or mechanical device to stabilize fractures, and typically involves the use of multiple needles as well as imaging guidance for precise placement. A bone biopsy may also be performed during the procedure.

Purpose

Sacroplasty is designed to treat sacral insufficiency fractures, which are breaks in the sacrum (part of the pelvis) often due to osteoporosis or other bone-weakening conditions. The goal of sacroplasty is to relieve pain, stabilize the fracture, and improve mobility and function.

Indications

• Chronic or severe lower back pain due to sacral insufficiency fractures
• Evidence of sacral fractures on imaging studies (e.g., X-ray, MRI)
• Osteoporosis or other bone-weakening conditions resulting in sacral fractures
• Pain unresponsive to conservative treatments (e.g., medications, physical therapy)

Preparation

• Fasting may be required for a few hours before the procedure.
• Discontinuation of certain medications, such as blood thinners, may be necessary.
• Pre-procedure imaging (e.g., MRI, CT scan) to assess the fracture and plan the procedure.
• Blood tests and medical evaluations to ensure patient safety.

Procedure Description

1. The patient lies face down on a procedure table.
2. Local anesthesia or conscious sedation is administered to ensure comfort.
3. Using real-time imaging guidance (such as fluoroscopy or CT), the physician inserts multiple needles into the affected area of the sacrum.
4. A balloon or mechanical device may be used to create a cavity within the bone and restore its shape.
5. Medical-grade bone cement is then injected into the cavity to stabilize the fracture.
6. Imaging confirms the correct placement of the cement.
7. A bone biopsy may be taken for further analysis if indicated.

Duration

The procedure typically takes 1 to 2 hours to complete.

Setting

Sacroplasty is usually performed in a hospital or an outpatient surgical center.

Personnel

• Interventional radiologist or spine surgeon
• Anesthesiologist or nurse anesthetist
• Radiologic technologist
• Nurses and support staff

Risks and Complications

• Infection at the injection site
• Bleeding or hematoma
• Leakage of bone cement into surrounding tissues
• Nerve damage resulting in pain or numbness
• Allergic reactions to materials used
• Rarely, pulmonary embolism if cement enters the bloodstream

Benefits

• Significant and rapid pain relief
• Stabilization of the sacral fracture
• Improved mobility and function
• Reduced reliance on pain medications
• Minimal invasiveness and shorter recovery time compared to open surgery

Recovery

• The patient may be observed for a few hours post-procedure and can often go home the same day.
• Mild soreness at the injection site is common and can be managed with oral pain relievers.
• Most patients can resume normal activities within a few days, but heavy lifting and strenuous exercise should be avoided for several weeks.
• Follow-up appointments to monitor progress and assess the effectiveness of the treatment.

Alternatives

• Conservative treatments such as physical therapy, pain medications, and bracing
• Vertebroplasty or kyphoplasty (for certain types of vertebral fractures)
• Open surgical repair, though significantly more invasive
• Pros and cons:
  • Conservative treatments are non-invasive but may not provide adequate pain relief.
  • Vertebroplasty or kyphoplasty may be considered for fractures in other vertebral regions.
  • Open surgery poses higher risks and longer recovery than sacroplasty.

Patient Experience

During the procedure, the patient will receive anesthesia to ensure comfort. Mild pressure or a sensation of movement may be felt but should not be painful. Post-procedure, some soreness at the injection sites is common but usually resolves within a few days. Pain relief from the stabilized fracture is typically noticed within days to weeks. Comfort measures include prescribed pain medications and instructions for gradual activity resumption.