Z Orthop Unfall 2019; 157(05): 524-533
DOI: 10.1055/a-0815-5073
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Clinical Improvement and Cost-effectiveness of CT-guided Radiofrequency Sacroplasty (RFS) and Cement Sacroplasty (CSP) – a Prospective Randomised Comparison of Methods

Cement Augmentation in Insufficiency Fractures of the Sacral Bone Article in several languages: English | deutsch
Reimer Andresen
1   Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg
,
Sebastian Radmer
2   Facharztpraxis für Orthopädie, Zentrum für Bewegungsheilkunde, Berlin
,
Julian Ramin Andresen
3   Medizinische Fakultät, Sigmund Freud PrivatUniversität, Wien, Österreich
,
Mathias Wollny
4   Reimbursement, Medimbursement, Tarmstedt
,
Urs Nissen
5   Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg
,
Hans-Christof Schober
6   Klinik für Innere Medizin I, Klinikum Südstadt Rostock, Akademisches Lehrkrankenhaus der Universität Rostock
› Author Affiliations
Further Information

Publication History

Publication Date:
08 February 2019 (online)

Abstract

Introduction The objective of this study was a comparative analysis of cement augmentation by means of RFS and CSP with regard to outcome and cost-effectiveness.

Patients and Methods CT-guided cement augmentation was performed on 100 patients with a total of 168 non-dislocated insufficiency fractures, 50 patients being treated with RFS and 50 patients with CSP. Leakages were detected by CT. Pain intensity was determined on a VAS before and after the intervention. The patientsʼ self-sufficiency was assessed using the Barthel index. Patients were asked about any complications and their level of satisfaction. Costs incurred for carrying out the procedure were compared with the respective reimbursements received.

Results Both procedures were technically fully feasible. No leakages were found in the RFS group, as opposed to 8.1% asymptomatic leakages in the CSP group. The mean value for pain before intervention was 8.8 in the RFS group and 8.7 in the CSP group. On the second postoperative day, there was a significant pain reduction with a value of 2.4 for both groups, which remained more or less constant over the follow-up period. The Barthel index increased significantly from an average of 30 before the intervention to 80 on the fourth postoperative day and 70 after 24 months. No differences were found between the two procedures with regard to pain, improvement in functional status and satisfaction. Taking into account the state-wide base rate used for calculating reimbursement, 3,834.75 € remained for RFS and 5,084.32 € for CSP.

Conclusion RFS and CSP are minimally invasive procedures that achieve equally good and sustained pain reduction, leading to markedly improved self-sufficiency of the patients. With regard to possible cement leakages, RFS is the safer method. A profit can be generated with both techniques.

 
  • References/Literatur

  • 1 Lourie H. Spontaneous osteoporotic fracture of the sacrum. An unrecognised syndrome of the elderly. JAMA 1982; 248: 715-717
  • 2 Wagner D, Ossendorf C, Gruszka D. et al. Fragility fractures of the sacrum: how to identify and when to treat surgically?. Eur J Trauma Emerg Surg 2015; 41: 349-362
  • 3 Lyders EM, Whitlow CT, Baker MD. et al. Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol 2010; 31: 201-210
  • 4 Nüchtern JV, Hartel MJ, Henes FO. et al. Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury 2015; 46: 315-319
  • 5 Schindler OS, Watura R, Cobby M. Sacral insufficiency fractures. J Orthop Surg (Hong Kong) 2007; 15: 339-346
  • 6 Aretxabala I, Fraiz E, Perez-Ruiz F. et al. Sacral insufficiency fractures. High association with pubic rami fractures. Clin Rheumatol 2000; 19: 399-401
  • 7 Alnaib M, Waters S, Shanshal Y. et al. Combined pubic rami and sacral osteoporotic fractures: a prospective study. J Orthop Traumatol 2012; 13: 97-103
  • 8 Grasland A, Pouchot J, Mathieu A. et al. Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med 1996; 156: 668-674
  • 9 Dasgupta B, Shah N, Brown H. et al. Sacral insufficiency fractures: an unsuspected cause of low back pain. Br J Rheumatol 1998; 37: 789-793
  • 10 Babayev M, Lachmann E, Nagler W. The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate?. Am J Phys Med Rehabil 2000; 79: 404-409
  • 11 Andresen R, Radmer S, Lüdtke CW. et al. [Conservative therapy versus CT guided balloon sacroplasty in the treatment of insufficiency fractures of the sacrum]. Osteologie/Osteology 2015; 24: 92-98
  • 12 Tjardes T, Paffrath T, Baethis H. et al. Computer assisted percutaneous placement of augmented iliosacral screws. Spine (Phila Pa 1976) 2008; 33: 1497-1500
  • 13 Klineberg E, McHenry T, Bellabarba C. et al. Sacral insufficiency fractures caudal to instrumented posterior lumbosacral arthrodesis. Spine (Phila Pa 1976) 2008; 33: 1806-1811
  • 14 Josten C, Höch A. [Fractures of the sacrum: operative/conservative]. Die Wirbelsäule 2017; 1: 31-40
  • 15 Butler CL, Given 2nd CA, Michel SJ. et al. Percutaneous sacroplasty for the treatment of sacral insufficiency fractures. AJR Am J Roentgenol 2005; 184: 1956-1959
  • 16 Heron J, Connell DA, James SL. CT-guided sacroplasty for the treatment of sacral insufficiency fractures. Clin Radiol 2007; 62: 1094-1100
  • 17 Frey ME, DePalme MJ, Cifu DX. et al. Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine (Phila Pa 1976) 2008; 8: 367-373
  • 18 Bayley E, Srinivas S, Boszczyk BM. Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature. Eur Spine J 2009; 18: 1266-1271
  • 19 Andresen R, Radmer S, Kamusella P. et al. [Interventional pain relief using balloon-kyphoplasty in patients with osteoporotic-based fatigue fractures of the os sacrum]. Rofo 2012; 184: 32-36
  • 20 Talmadge J, Smith K, Dykes T. et al. Clinical impact of sacroplasty on patient mobility. J Vasc Interv Radiol 2014; 25: 911-915
  • 21 Onen MR, Yuvruk E, Naderi S. Reliability and effectiveness of percutaneous sacroplasty in sacral insufficiency fractures. J Clin Neurosci 2015; 22: 1601-1608
  • 22 Andresen R, Radmer S, Wollny M. et al. [CT-guided balloon sacroplasty (BSP), radiofrequency sacroplasty (RFS), vertebrosacroplasty (VSP) and cement sacroplasty (CSP) in non-dislocated insufficiency fractures – a comparison of methods with regard to outcome, costs and reimbursement]. Die Wirbelsäule 2018; 2: 75-84
  • 23 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 2013; 44: 1733-1744
  • 24 Pfeilschifter J, Baum E, Braun J. et al. DVO guideline 2009 for prevention, diagnosis and therapy of osteoporosis in adults. Osteologie/Osteology 2011; 20: 55-74
  • 25 Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 1988; 227: 67-81
  • 26 Andresen R, Radmer S, Kamusella P. et al. Treatment of Denis 1, 2 and 3 insufficiency fracture zones of the os sacrum. Individual approaches adapted to the course of the fracture in CT-assisted balloon sacroplasty. Osteologie/Osteology 2012; 21: 168-173
  • 27 Lübke N, Meinck M, von Renteln-Kruse W. [The Barthel Index in geriatrics. A context analysis for the Hamburg Classification Manual]. Z Gerontol Geriatr 2004; 37: 316-326
  • 28 Institut für das Entgeltsystem im Krankenhaus (InEK). G-DRG Report-Browser für HA V2015/2017. Im Internet: http://www.g-drg.de/G-DRG-System_2017/Abschlussbericht_zur_Weiterentwicklung_des_G-DRG-Systems_und_Report_Browser/Report-Browser_2017 Stand: 15.03.2018
  • 29 Institut für das Entgeltsystem im Krankenhaus (InEK). Kalkulation von Fallkosten. Handbuch zur Anwendung in Krankenhäusern. Version 3.0, 2007, DKVG mbH. Im Internet: http://www.g-drg.de/Kalkulation2/DRG-Fallpauschalen_17b_KHG/Kalkulationshandbuch Stand: 03.10.2016
  • 30 Statistisches Bundesamt. Stationäre Krankenhauskosten 2015 auf 84,2 Milliarden Euro gestiegen. Pressemitteilung Dezember 2016-464/16. Im Internet: https://www.destatis.de/DE/PresseService/Presse/Pressemitteilungen/2016/12/PD16_464_231.html Stand: 22.12.2016
  • 31 Garant M. Sacroplasty: a new treatment for sacral insufficiency fracture. J Vasc Interv Radiol 2002; 13: 1265-1267
  • 32 Bastian JD, Keel MJ, Heini PF. et al. Complications related to cement leakage in sacroplasty. Acta Orthop Belg 2012; 78: 100-105
  • 33 Andresen R, Radmer S, Wollny M. et al. CT-guided cement sacroplasty (CSP) as pain therapy in non-dislocated insufficiency fractures. Eur J Orthop Surg Traumatol 2017; 27: 1045-1050
  • 34 Prokop A, Andresen R, Chmielnicki M. [Balloonsacroplasty: C-arm or CT controlled application?: Experience with 46 patients]. Unfallchirurg 2016; 119: 929-935
  • 35 Andresen R, Lüdtke CW, Radmer S. et al. Radiofrequency sacroplasty (RFS) for the treatment of osteoporotic insufficiency fractures. Eur Spine J 2015; 24: 759-763
  • 36 Eichler K, Zangos S, Mack MG. et al. Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures with a radiofrequency-induced, high-viscosity bone cement. Skeletal Radiol 2014; 43: 493-498
  • 37 Yang SC, Tsai TT, Chen HS. et al. Comparison of sacroplasty with or without balloon assistance for the treatment of sacral insufficiency fractures. J Orthop Surg (Hong Kong) 2018; 26: 1-8
  • 38 Andresen R, Radmer S, Andresen JR. et al. Comparison of the 18 months outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study. Eur Spine J 2017; 26: 3235-3240
  • 39 Richards AM, Mears SC, Knight TA. et al. Biomechanical analysis of sacroplasty: does volume or loacation of cement matter?. AJNR Am J Neuroradiol 2009; 30: 315-317
  • 40 Trouvin AP, Alcaix D, Somon T. et al. Analgesic effect of sacroplasty in osteoporotic sacral fractures: a study of six cases. Joint Bone Spine 2012; 79: 500-503
  • 41 Andresen R, Radmer S, Banzer D. Bone mineral density and spongiosa architecture in correlation to vertebral body insufficiency fractures. Acta Radiol 1998; 39: 538-542
  • 42 Krüger A, Wollny M, Oberkircher L. et al. [Revenue and losses with vertebral augmentation under the G-DRG system 2012 – a comparison of supply costs in the context of vertebroplasty and kyphoplasty]. Z Orthop Unfall 2012; 150: 539-546
  • 43 Krüger A, Oberkircher L, Ruchholtz S. et al. [Reimbursement for kyphoplasty in the German diagnosis-related groups system 2011/2012. Material costs versus treatment costs]. Unfallchirurg 2014; 117: 54-59