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Spine
Diagnosis
Trauma
Vertebral Column, Discs, and Paraspinal Muscle
Sacral Insufficiency Fracture
Sacral Insufficiency Fracture
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Sacral fracture resulting from normal physiologic stress on weakened (e.g., osteoporotic) bone

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Other Modality Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Gibbs WN et al: Sacral fractures and sacroplasty. Neuroimaging Clin N Am. 29(4):515-27, 2019
                                      2. Pulley BR et al: Surgical fixation of geriatric sacral U-type insufficiency fractures: a retrospective analysis. J Orthop Trauma. 32(12):617-22, 2018
                                      3. Park JW et al: Mortality following benign sacral insufficiency fracture and associated risk factors. Arch Osteoporos. 12(1):100, 2017
                                      4. Eichler K 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. 43(4):493-8, 2014
                                      5. Wilde GE et al: Sacral fractures after lumbosacral fusion: a characteristic fracture pattern. AJR Am J Roentgenol. 197(1):184-8, 2011
                                      6. Lyders EM et al: Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol. 31(2):201-10, 2010
                                      7. Linstrom NJ et al: Anatomical and biomechanical analyses of the unique and consistent locations of sacral insufficiency fractures. Spine (Phila Pa 1976). 34(4):309-15, 2009
                                      8. Muthukumar T et al: Cauda equina syndrome presentation of sacral insufficiency fractures. Skeletal Radiol. 36(4):309-13, 2007
                                      9. Schindler OS et al: Sacral insufficiency fractures. J Orthop Surg (Hong Kong). 15(3):339-46, 2007
                                      10. Fujii M et al: Honda sign and variants in patients suspected of having a sacral insufficiency fracture. Clin Nucl Med. 30(3):165-9, 2005
                                      11. Pommersheim W et al: Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol. 24(5):1003-7, 2003
                                      12. White JH et al: Imaging of sacral fractures. Clin Radiol. 58(12):914-21, 2003
                                      13. Dasgupta B et al: Sacral insufficiency fractures: an unsuspected cause of low back pain. Br J Rheumatol. 37(7):789-93, 1998
                                      14. Grangier C et al: Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radiol. 26(9):517-24, 1997
                                      15. Peh WC et al: Vacuum phenomena in the sacroiliac joints and in association with sacral insufficiency fractures. Incidence and significance. Spine (Phila Pa 1976). 22(17):2005-8, 1997
                                      16. Grasland A et al: Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med. 156(6):668-74, 1996
                                      17. Peh WC et al: Imaging of pelvic insufficiency fractures. Radiographics. 16(2):335-48, 1996
                                      18. Peh WC et al: Sacral insufficiency fractures. Spectrum of radiological features. Clin Imaging. 19(2):92-101, 1995
                                      19. Stäbler A et al: Vacuum phenomena in insufficiency fractures of the sacrum. Skeletal Radiol. 24(1):31-5, 1995
                                      20. Baker RJ Jr et al: Sacral insufficiency fracture: half of an "H". Clin Nucl Med. 19(12):1106-7, 1994
                                      21. West SG et al: Sacral insufficiency fractures in rheumatoid arthritis. Spine. 19(18):2117-21, 1994
                                      22. Blomlie V et al: Radiation-induced insufficiency fractures of the sacrum: evaluation with MR imaging. Radiology. 188(1):241-4, 1993
                                      23. Weber M et al: Insufficiency fractures of the sacrum. Twenty cases and review of the literature. Spine. 18(16):2507-12, 1993
                                      24. Kayes K et al: Radiologic case study. Sacral insufficiency fracture. Orthopedics. 14(7):817-8, 820, 1991
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Definitions

                                                • Sacral fracture resulting from normal physiologic stress on weakened (e.g., osteoporotic) bone

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Nuclear Medicine Findings

                                                        • Other Modality Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Gibbs WN et al: Sacral fractures and sacroplasty. Neuroimaging Clin N Am. 29(4):515-27, 2019
                                                                          2. Pulley BR et al: Surgical fixation of geriatric sacral U-type insufficiency fractures: a retrospective analysis. J Orthop Trauma. 32(12):617-22, 2018
                                                                          3. Park JW et al: Mortality following benign sacral insufficiency fracture and associated risk factors. Arch Osteoporos. 12(1):100, 2017
                                                                          4. Eichler K 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. 43(4):493-8, 2014
                                                                          5. Wilde GE et al: Sacral fractures after lumbosacral fusion: a characteristic fracture pattern. AJR Am J Roentgenol. 197(1):184-8, 2011
                                                                          6. Lyders EM et al: Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol. 31(2):201-10, 2010
                                                                          7. Linstrom NJ et al: Anatomical and biomechanical analyses of the unique and consistent locations of sacral insufficiency fractures. Spine (Phila Pa 1976). 34(4):309-15, 2009
                                                                          8. Muthukumar T et al: Cauda equina syndrome presentation of sacral insufficiency fractures. Skeletal Radiol. 36(4):309-13, 2007
                                                                          9. Schindler OS et al: Sacral insufficiency fractures. J Orthop Surg (Hong Kong). 15(3):339-46, 2007
                                                                          10. Fujii M et al: Honda sign and variants in patients suspected of having a sacral insufficiency fracture. Clin Nucl Med. 30(3):165-9, 2005
                                                                          11. Pommersheim W et al: Sacroplasty: a treatment for sacral insufficiency fractures. AJNR Am J Neuroradiol. 24(5):1003-7, 2003
                                                                          12. White JH et al: Imaging of sacral fractures. Clin Radiol. 58(12):914-21, 2003
                                                                          13. Dasgupta B et al: Sacral insufficiency fractures: an unsuspected cause of low back pain. Br J Rheumatol. 37(7):789-93, 1998
                                                                          14. Grangier C et al: Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radiol. 26(9):517-24, 1997
                                                                          15. Peh WC et al: Vacuum phenomena in the sacroiliac joints and in association with sacral insufficiency fractures. Incidence and significance. Spine (Phila Pa 1976). 22(17):2005-8, 1997
                                                                          16. Grasland A et al: Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med. 156(6):668-74, 1996
                                                                          17. Peh WC et al: Imaging of pelvic insufficiency fractures. Radiographics. 16(2):335-48, 1996
                                                                          18. Peh WC et al: Sacral insufficiency fractures. Spectrum of radiological features. Clin Imaging. 19(2):92-101, 1995
                                                                          19. Stäbler A et al: Vacuum phenomena in insufficiency fractures of the sacrum. Skeletal Radiol. 24(1):31-5, 1995
                                                                          20. Baker RJ Jr et al: Sacral insufficiency fracture: half of an "H". Clin Nucl Med. 19(12):1106-7, 1994
                                                                          21. West SG et al: Sacral insufficiency fractures in rheumatoid arthritis. Spine. 19(18):2117-21, 1994
                                                                          22. Blomlie V et al: Radiation-induced insufficiency fractures of the sacrum: evaluation with MR imaging. Radiology. 188(1):241-4, 1993
                                                                          23. Weber M et al: Insufficiency fractures of the sacrum. Twenty cases and review of the literature. Spine. 18(16):2507-12, 1993
                                                                          24. Kayes K et al: Radiologic case study. Sacral insufficiency fracture. Orthopedics. 14(7):817-8, 820, 1991
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