Percutaneous Vertebroplasty

Abstract

Vertebroplasty, the augmentation of vertebral compression fractures by image-controlled intracorporeal injection of polymethylmethacrylate cement, has shown a steady increase in use. Its chief indication is to palliate pain after a failure of noninvasive therapies. Other benefits include preventing further compression of the treated vertebra and fusing unstable fractures. Controversies include questions regarding its long-term benefit compared with natural history, claims of height restoration, biomechanical compromise of adjacent vertebrae, and its performance compared with kyphoplasty. Complications are uncommon but can be devastating with reported cases of procedural death and paralysis. New operators should be adequately trained and respect the dangers of this procedure.

Clinical Reasoning:

“…6 Now it is extensively used for stabilization of osteoporotic fractures. 7 PV is an efficient treatment but is not free of complications.…”

“…8 Cement leakage into prevertebral soft tissue, epidural space, foraminal ring, intervertebral disc, and venous and arterial beds represents the main source of complications. 8 Less frequently, life-threatening complications were reported, 6 such as highlighting pulmonary arterial embolism, ARDS, stroke, spinal cord compression syndromes, and death during or immediately after the procedure (table e-1 on the Neurology ® Web site at www.neurology.org). 6,8 Neurologic complications are mainly secondary to cement leakage into spinal canal and less frequently into intervertebral foramen producing a compressive syndrome.…”

“…8 Less frequently, life-threatening complications were reported, 6 such as highlighting pulmonary arterial embolism, ARDS, stroke, spinal cord compression syndromes, and death during or immediately after the procedure (table e-1 on the Neurology ® Web site at www.neurology.org). 6,8 Neurologic complications are mainly secondary to cement leakage into spinal canal and less frequently into intervertebral foramen producing a compressive syndrome. 6,8 Multiple mechanisms are potentially involved in PMMA-induced injury (figure e-1).…”

“…6,8 Neurologic complications are mainly secondary to cement leakage into spinal canal and less frequently into intervertebral foramen producing a compressive syndrome. 6,8 Multiple mechanisms are potentially involved in PMMA-induced injury (figure e-1). Potentially, PMMA causes direct damage in different ways.…”

“…6,8 PMMA also causes an intense local inflammatory reaction with generation of cytokines, oxygen free radicals, and excitatory aminoacids that contribute to chemical cellular injury. 6,8 PMMA can also act as space-occupying lesion in the spinal canal. The PMMA effects in the spinal canal and in the subarachnoid space have been little studied and reported.…”