Percutaneous sacroplasty for the management of painful pathologic fracture in a multiple myeloma patient: Case report and review of the literature.

ABSTRACT

Percutaneous kyphoplasty has a well-established role in the treatment of pathologic fractures in patients with multiple myeloma. Despite this, there is a scarcity of literature surrounding its use and efficacy in the sacrum. We present a case of successful symptom resolution in a patient with painful sacral fracture following sacroplasty, and review the existing literature. An 81-year-man with multiple myeloma presented to the hematology/oncology clinic with a history of excruciating pain while seated. The impact of this pain on his quality of life subjectively was rated to be particularly high. Computed tomography of the sacrum confirmed the presence of pathologic fracture within the S1 and S2 vertebrae. Under fluoroscopic guidance, polymethyl methacrylate (PMMA) bone cement was injected via 11-gauge needles using an anterior-oblique approach. No immediate post-procedural complications occurred, such as foraminal extravasation or venous injection. The patient reported himself to be pain-free 1 day following the procedure, and this remains the case to date at 2 years of follow-up. Sacroplasty is technically feasible and can provide durable relief of symptoms in patients with painful pathologic fractures of the sacrum. It is likely underused and can offer tremendous benefit to myeloma patients.