1431 - A case for sacroplasty intervention to address a chronic sacral insufficiency fracture while in inpatient rehab.

An 84-year-old woman with osteopenia, polymyalgia rheumatica, and chronic low back pain was admitted to inpatient rehabilitation (IPR) for recurrent falls and impaired ambulation.  

During IPR, MRI revealed a sacral insufficiency fracture (SIF) involving the right sacral ala. Her pain management history included multiple interventions—repeat radiofrequency ablations, bilateral hip injections, lumbar epidural steroid injections, sacroiliac joint injections, and trigger point injections—without sustained relief. She reported persistent right-sided low back pain radiating to the groin for over one year.  

At admission, medications included Tylenol, Flexeril 5 mg BID, gabapentin 100 mg qHS, and prn oxycodone 5/10 mg q4h (taking 3-5x/day), contributing to opioid-induced constipation. Pain continued to limit therapy participation; therefore, CT-guided sacroplasty was performed. Post-procedure, she progressed from contact-guard to supervision assistance, and her pain regimen requirement decreased, improving both mobility and bowel function. 


Discussions: SIFs are typically associated with osteoporosis and occur predominantly in the elderly. They are often chronic at diagnosis due to delayed recognition and can cause severe sacral low back pain. Surgical fixation is an option but poses challenges in osteoporotic bone due to poor screw purchase. Sacroplasty, an alternative treatment, involves percutaneous injection of acrylic bone cement into the fracture site to stabilize the sacrum and alleviate pain. As a result, this minimally invasive approach was shown to improve mobility, reduce reliance on opioids, and minimize associated complications such as constipation, making it an attractive option for frail older adults. 

Conclusions: This case demonstrates the effectiveness of sacroplasty in managing chronic pain from sacral insufficiency fractures, leading to significant pain relief and functional gains during inpatient rehabilitation.