Comparison of low-dose CT with CT/CT Fluoroscopy guidance in percutaneous sacral and supra-acetabular cementoplasty.

PURPOSE Percutaneous cementoplasty is a minimally invasive treatment modality for painful osteoporotic and pathologic sacral and supra-acetabular iliac fractures. This study compares the use of low-dose CT guidance with CT/CT fluoroscopy in sacral and supra-acetabular cementoplasty. METHODS A retrospective review of patients who had undergone sacral or supra-acetabular cementoplasty was performed with patients grouped by use of CT/CT Fluoroscopy or low-dose CT guidance during the procedure. Parameters evaluated included type of fracture, laterality of lesions, pain scores, pain medication use, imaging parameters, procedure time, dose length product, effective dose, cement volume, and complications. RESULTS There were 17 patients identified who underwent cementoplasty utilizing dual CT/CT Fluoroscopy, while 13 patients had their procedures performed with low-dose CT. There was a statistically significant decrease in radiation dose in the low-dose CT group (1481 mGy-cm) compared to the CT/CT Fluoroscopy group (2809mGy-cm) (P = 0.013). There was a significant decrease in procedure time with low-dose CT for bilateral lesions (P = 0.016). There was no significant difference between groups in complication rate (P = 0.999). Non-clinically significant cement extravasation occurred in two patients (10%) in the CT/CT Fluoroscopy group and in one patient (8%) in the low-dose CT group (P = 0.999). There was a significant decrease in pain scores compared to baseline on the Visual Analogue Scale in both groups at 1 week (low-dose CT P = 0.002, CT/CTF P = 0.008) and 1 month post-procedure (low dose CT P = 0.014, CT/CTF P = 0.004), but no difference between groups at 1 day (P = 0.196), 1 week (P = 0.368), or 1 month (P = 0.514). CONCLUSION Sacral and supra-acetabular cementoplasties can be performed safely and precisely using low dose multiple-acquisition CT guidance while providing significant radiation dose reduction with no difference in extravasation rates, post-procedural pain reduction and complications compared to CT/CT Fluoroscopy.