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Sacral Insufficiency Fracture

What does Sacral Insufficiency Fracture mean?

A sacral insufficiency fracture is a broken tailbone. The tailbone is broken in the sacrum. The sacrum is the large wedge shaped bone, whereas the coccyx is the small set of bones located at the end of the sacrum.

How do patients break the tailbone?

When patients “break their tailbone”, they usually do so at the coccyx. This is often the result of a fall on the buttocks.

A fracture of the sacrum (sacral insufficieny fracture) is different from a fracture of the coccyx. It is often related to bone thinning (osteoporosis) and does not take a fall or significant trauma to happen.

Why do patients get a Sacral Insufficiency Fracture?

Patients usually suffer Sacral Insufficiency Fractures because the bone quality (stiffness, firmness) is not good enough to handle the stress and weight place on it. This is usually due to bone thinning (Osteoporosis).

While osteoporosis related Sacral Insuffiency Fractures are the most common, fractures of the sacrum can also occur due to trauma or bone cancer.

How do Sacral Insufficiency Fractures happen?

Here are some of the common causes of Vertebral Compression Fractures:

  1. Just bearing the weight of the body
  2. A strong cough or sneeze
  3. Bending forward
  4. Lifting something heavier
  5. Fall on the buttock area

Where in the spine do Vertebral Compression Fractures usually occur?

VCF’s most commonly occur in the mid-back (thoracic spine), and low-back (lumbar spine).

The most common spinal levels affected are T7, T8, T12 and L1.

However they can also happen in the Sacrum, albeit much less frequently.

How long do Sacral Insufficiency Fractures take to heal?

This depends on the reason for the fracture. Fractures related to trauma and osteoporosis tend to heal within 8 weeks. Fractures related to cancer may not heal completely.

Can Sacral Insufficiency Fractures cause nerve problems?

The sacral spinal nerves travel through the sacrum. Some Sacral Insufficiency Fractures can trap these nerves and cause nerve pain in the buttocks, groin and legs.

What are the common symptoms from a Sacral Insufficiency Fracture?

These fractures may not cause symptoms. Here are some common symptoms for the ones which do:

  1. Hip pain
  2. Buttock pain
  3. Groin pain
  4. Pain with walking and sitting

How are Sacral Insufficiency Fractures diagnosed?

Spine specialists use information from the patient history, physical examination and spine tests to make the diagnosis of this condition.

  1. History

A history of a sudden onset of buttock, hip and groin pain especially in patient with known or suspected Osteoporosis can be a tip off for a Sacral Insufficiency Fracture.

      2. Physical Examination

Here are some examinations the doctor may perform to help diagnose a VCF:

  1. Pushing and touching the spine (palpation) looking for pain, swelling and deformity
  2. Mobility testing (range of motion)
  3. Sensory (sensation) testing in the buttock, rectum and legs
  4. Muscle strength (motor) testing in the legs
  5. Reflex testing in the legs

      3. Imaging Tests

a. X-Ray

X-Rays of the spine usually do not show a Sacral Insufficiency Fracture.

b. CT Scan

CT scans are excellent tools to see the bone anatomy of the spine. They can show this fracture. The spinal nerves cannot be seen.

c. MRI Scans

MRI scans can show these fractures. While MRI technology is not as good as a CT scan to show specific details of the vertebral bones, it is an excellent tool to see the swelling from a broken sacrum, and a potential compression of the spinal nerves.

d. Nuclear Bone Scan

Nuclear bone scans, especially SPECT (Single Photon Emission Computed Tomography) show the activity in the fracture which is created by the body’s attempt to heal it. It can be very specific for a Sacral Insufficiency Fracture. However it does not show if the sacral nerves are compressed.

How are Sacral Insufficiency Fractures treated?

Here are some examples of surgical and non-surgical treatments:

  1. Non-Surgical Care

Here are some common non-surgical treatments available

  1. Medications:
    • Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
    • Muscle Relaxants
    • Pain Killers

      2. Activity Restriction

Typically it is recommended to limit bending, twisting, lifting and any other higher impact activity such as brisk walking or running.

      3. Physical Therapy (PT)

PT can help mobilize patients who are suffering from the pain related to the Sacral Insufficiency Fracture.

      4. Massage Therapy

Massage therapy techniques can help with the muscle component of the pain.

      5. Alternative Health Care

Alternative health options can complement traditional medicine.

      6. Minimally Invasive Treatments

A minimally invasive option is available for some patients with this problem: Sacral Vertebroplasty

      2. Surgical Care

Surgical treatments for Sacral Insufficiency Fractures are usually only done for those resulting from trauma or cancer. An exception would be an Osteoporosis related fracture which is creating pressure on the spinal nerves. In this case, the bone pressing on the spinal nerves may have to be removed.