Skip to Main Content




Sacral insufficiency fractures are a common, but often underdiagnosed source of low back pain in the elderly osteoporotic patient. Fractures of the pelvis are a consequence of undue stress onto a weakened bone. Osteoporosis is the most common cause of fractures of the pelvis. Major or minor trauma is another cause; however, spontaneous sacral insufficiency fractures are also common. The incidence of sacral insufficiency fractures comprises of approximately 1% to 2% of pathologic fractures involving the spine and pelvis. However, these fractures are often misdiagnosed and unrecognized. Risks of sacral insufficiency fractures are very similar to that of vertebral compression fractures.


The treatment of sacral insufficiency fractures can either be noninterventional, interventional, or surgical. Unstable fractures, especially with associated cauda equina syndrome, may require closed manipulation or open reduction and internal fixation procedures. Open reduction procedures as compared to percutaneous reduction have increased risks, especially infection.


  • Conventionally, treatment in the past has been mainly bed rest, opiate analgesic management, using a walker with partial weight-bearing and early mobilization, and lumbosacral or pelvic corsets.

  • Deep venous thromboses and pulmonary emboli, reduced muscle strength with prolonged recovery, postural hypotension and impaired cardiac function, atelectasis and pneumonia. Skin breakdown and pressure ulcers, constipation and fecal impaction, depression and intellectual regression are known complications of prolonged periods of inactivity.

  • The overall 1-year mortality rate associated with pelvic insufficiency fractures is 14.3% and 50% of affected patients will not return to their prior level of function.

  • Although initial clinical improvement may occur rapidly, compete resolution of symptoms may not occur for up to 9 to 12 months.

  • Despite a favorable natural history, more aggressive treatments may benefit certain patients who are incapacitated by painful sacral insufficiency fractures.


Chronic symptoms and disability related to osteoporotic insufficiency fractures are believed to be due to fracture nonunion, micromotion, or resultant deformity related to the anemic attempts of the weakened bone to heal. The percutaneous injection of polymethylmethacrylate (PMMA) into fractured vertebral bodies (vertebroplasty) has been safely performed to successfully treat painful osteoporotic compression fractures. A natural extension in the application of vertebroplasty is the percutaneous injection of synthetic bone cement into the fractured sacrum (sacroplasty) to treat persistent symptoms and disability. Sacroplasty was first reported in 2001 as treatment of symptomatic sacral metastatic lesions, and subsequent reports have documented its safe and effective performance.




  • Once suspicion of a sacral insufficiency fracture is suspected, then appropriate imaging is necessary. Some patient may already have had normal spinal or pelvic radiographs.

  • The gold standard, which yields the highest sensitivity and specificity, is a magnetic resonance imaging (MRI). If a patient has a pacemaker or other condition that precludes obtaining an MRI, a computed tomography (CT) is necessary to compliment the bone scan. CT scans are more sensitive; however, nondisplaced fractures without reactive sclerosis may be missed.

  • Fractures of the sacrum are best shown on coronal ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.