Treatment of bilateral sacral insufficiency fractures with sacroplasty in a patient with motor complete tetraplegia

INTRODUCTION: Osteoporosis is a common secondary complication of spinal cord injury, with fragility fractures typically occurring in the lower body and management often is conservative. CASE PRESENTATION: We present a 52-year-old male with chronic complete tetraplegia who presented to the emergency room with unremitting autonomic dysreflexia (AD). He was admitted for medical management of the AD when a source of the AD could not be identified. After an extensive workup, the patient was found to have bilateral sacral insufficiency fractures. He subsequently underwent sacroplasty with immediate and full resolution of AD symptoms and return to full premorbid function within 24 h. DISCUSSION: People with chronic spinal cord injury (SCI) are at risk for spinal column fragility fractures in addition to lower extremity fractures. Vertebroplasty may be a safe option for treatment of insufficiency fractures in situations where conservative care may put people at risk for significant immobility-associated complications.