Percutaneous vertebroplasty: Technique and results in 192 procedures

Abstract

Percutaneous vertebroplasty with acrylic cement (usually polymethylmethacrylate) consists of injecting cement into vertebral bodies weakened by osseous lesions. The objective of this procedure is to obtain an analgesic effect by mechanical stabilization in destructive lesions of the spine. The three major indications are aggressive vertebral hemangiomas, severe or refractory pain related to osteoporotic vertebral fractures, and malignant vertebral tumors. Complications are infrequent, but occur essentially in patients with vertebral malignant tumors. We present our experience with 148 patients that underwent 192 percutaneous PMMA vertebroplasties for the treatment of painful osteoporotic compression fractures (76 patients, 105 vertebral levels), hemangiomas (31 patients, 43 vertebral levels) and neoplasms (31 patients, 43 vertebral levels). In a vast majority of appropriately selected cases and especially in osteoporotic cases, vertebroplasty constitutes a relatively simple procedure with a very high rate of success.

Percutaneous vertebroplasty: the follow-up

“…Patients treated with the procedure reported complete or partial pain relief immediately after the procedure: 24 h after in 88% of cases of osteoporotic fractures and in 84% of cases of neoplastic fractures. These data confirm the high success rates reported by other authors [4,5,[18][19][20][21]. No patient reported pain worsening, whereas patients who failed to benefit significantly from the procedure were affected by fractures more than 6 months old.…”

“…Noncorrectable coagulopathy 8. Allergy to any materials used during the procedure Before the procedure, patients underwent clinical assessment to evaluate the site and intensity of pain, which had to be: severe, focal, located along the midline, exacerbated by palpation of the spinous process of the involved vertebra and by spinal flexion, and in the absence of radicular symptoms [3,4].…”

“…I pazienti che abbiamo sottoposto alla procedura hanno riferito la scomparsa o la significativa riduzione del dolore immediatamente dopo la procedura e dopo 24 ore nel 88% dei casi quando colpiti da crollo osteoporotico, e nel 84% quando affetti da localizzazione neoplastica. Questi dati confermano quelli di altri autori riportanti alte percentuali di successo [4,5,[18][19][20][21]. In nessun soggetto si è avuto un peggioramento della sintomatologia, mentre i pazienti che non hanno tratto sollievo in maniera significativa dal trattamento erano affetti da fratture datate oltre sei mesi.…”

Advances in the therapy of cancer pain: from novel experimental models to evidence-based treatments

“…The main indications for vertebroplasty are osteolytic metastases and myeloma, painful hemangioma, and osteoporotic vertebral fractures with intractable pain despite optimal medical treatment (156,157,162). This procedure does have a role in the management of pain in patients suffering from metastases to the spine, something supported by a large number of studies (156,158,160,(162)(163)(164)(165)(166)(167)(168)(169)(170). Success rates, with regard to pain relief and functional improvement, are approximately 90%, for up to one year follow up (165)(166)(167)(168)170).…”

“…This procedure does have a role in the management of pain in patients suffering from metastases to the spine, something supported by a large number of studies (156,158,160,(162)(163)(164)(165)(166)(167)(168)(169)(170). Success rates, with regard to pain relief and functional improvement, are approximately 90%, for up to one year follow up (165)(166)(167)(168)170). Complications are extremely rare (165,171), but because of the potential of methyl methacrylate leakage causing intravascular embolic phenomena or compression on the spinal cord or nerve roots, the technique requires expertise and performance in a multidisciplinary environment wherein neurosurgical support is available.…”