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

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.

Key words

insufficiency fracture - sacrum - radiofrequency sacroplasty - pain therapy - cement sacroplasty

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