Sacroplasty for Zone III Sacral Insufficiency Fracture: A Case Report Utilizing a Midline Approach and Articulating Osteotome.

Background: Sacral insufficiency fractures can be a debilitating cause of low back pain in the elderly population. While sacroplasty is recommended for the treatment of persistent pain from sacral insufficiency fractures, the anatomical location of Zone III fractures can put patients at a higher risk of neurological complications during repair.

Case report: We present a case of a 71-year-old woman with a Denis Zone III sacral insufficiency fracture who underwent percutaneous sacroplasty. The procedure was performed by utilizing an articulating osteotome in the long-axis approach along the curvature of the sacrum. The use of an articulating osteotome allowed for small trajectory adjustments, thereby lowering the procedural risks of cement extravasation and erroneous cannulation.

Conclusions: The patient reported significant pain relief and no immediate complications following the procedure. Fluoroscopically guided percutaneous sacroplasty using an articulating osteotome is a safe and effective method for treating sacral insufficiency fractures.