Percutaneous vertebroplasty with acrylic cement in the treatment of osteoporotic vertebral crush fracture syndrome

Debussche-Depriester, Claude; Deramond, H.; Fardellone, Patrice; Heleg, A.; Sébert, J. L.; Cartz, L.; Galibert, P

doi:10.1007/978-3-642-49329-4_50

Cited by 38 publications

(43 citation statements)

References 4 publications

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“…Conservative management of osteoporotic compression fractures includes analgesic drugs, surgical corsets, and physical therapy, which has been the standard treatment for decades. Percutaneous vertebroplasty has emerged as a widely accepted treatment modality for medically refractory osteoporotic compression fractures and is also used for metastatic vertebral fractures in order to stabilize the vertebral bodies parallel to radiotherapy or chemotherapy [5][6][7][8][9][10]. Numeous potential complications have been reported in the literature [6][7][8][9][10][11][12], including the hypothesis that the restored stiffness of the augmented vertebra itself might propagate secondary fractures in adjacent nonaugmented vertebrae [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

et al. 2008

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The aim of this study was to analyze the technical results, the extraosseous cement leakages, and the complications in our first 500 vertebroplasty procedures. Patients with osteoporotic vertebral compression fractures or osteolytic lesions caused by malignant tumors were treated with CT-guided vertebroplasty. The technical results were documented with CT, and the extraosseous cement leakages and periinterventional clinical complications were analyzed as well as secondary fractures during follow-up. Since 2002, 500 vertebroplasty procedures have been performed on 251 patients (82 male, 169 female, age 71.5 +/- 9.8 years) suffering from osteoporotic compression fractures (n = 217) and/or malignant tumour infiltration (n = 34). The number of vertebrae treated per patient was 1.96 +/- 1.29 (range 1-10); the numbers of interventions per patient and interventions per vertebra were 1.33 +/- 0.75 (range 1-6) and 1.01 +/- 0.10, respectively. The amount of PMMA cement was 4.5 +/- 1.9 ml and decreased during the 5-year period of investigation. The procedure-related 30-day mortality was 0.4% (1 of 251 patients) due to pulmonary embolism in this case. The procedure-related morbidity was 2.8% (7/251), including one acute coronary syndrome beginning 12 h after the procedure and one missing patellar reflex in a patients with a cement leak near the neuroformen because of osteolytic destruction of the respective pedicle. Additionally, one patient developed a medullary conus syndrome after a fall during the night after vertebroplasty, two patients reached an inadequate depth of conscious sedation, and two cases had additional fractures (one pedicle fracture, one rib fracture). The overall CT-based cement leak rate was 55.4% and included leakages predominantly into intervertebral disc spaces (25.2%), epidural vein plexus (16.0%), through the posterior wall (2.6%), into the neuroforamen (1.6%), into paravertebral vessels (7.2%), and combinations of these and others. During follow-up (15.2 +/- 13.4 months) the secondary fracture rate was 17.1%, including comparable numbers for vertebrae at adjacent and distant levels. The presence of intradiscal cement leaks was not associated with increased adjacent fracture rates. CT-guided vertebroplasty is safe and effective for treatment of vertebral compression fractures. CT-fluoroscopy provides an excellent control of the posterior vertebral wall. The number of cement leakages alone is not directly associated with clinical complications. However, even small volumes of pulmonary PMMA embolism might be responsible for the fatal outcome in cases with underlying cardiopulmonary insufficiency.

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Section: Introductionmentioning

confidence: 99%

CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

et al. 2008

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“…Since the first percutaneous vertebroplasty (PVP) was reported in 1987 for treatment of a painful hemangioma in the cervical spine of a young female patient [3], the indications of PVP have extended to vertebral compression fractures (VCF) secondary to osteoporosis [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients

et al. 2004

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To assess the immediate efficacy of percutaneous vertebroplasty (PVP) in relief of pain and improving mobility of patients with vertebral compression fractures (VCF) secondary to osteoporosis, 205 cases (175 patients) underwent 250 percutaneous injections of polymethylmethacrylate (PMMA; unilateral, 247 levels; bilateral, 3 levels) into vertebrae under CT and fluoroscopic guidance for 34 months. Patients were prospectively asked to quantify their pain on a visual analog scale (VAS) before and a day after PVP. The interval to mobilization was recorded in those who were immobilized because of pain and/or bed-rest therapy (115 cases). PVP was technically successful in all patients, with three cases of minimal complications. The mean VAS score available for 196 cases was improved from 7.22+/-1.89 (range, 3-10) to 2.07+/-1.19 (range, 0-10) by PVP. Ninety-four of 115 immobilized cases (81.7%) were mobile by 24 h after PVP, and the mean value was 1.9+/-2.8 days. The incidence of recurrent and new fractures was 15.6% in 4-25 months (mean, 15.3 months). PVP is a safe and effective treatment for relieving the pain associated with osteoporotic VCF and strengthening the vertebrae, avoiding refractures. This therapy leads to early mobilization and avoidance of the dangers of conservative therapy of bed-rest.

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“…Augmentation of the vertebral body by percutaneous polymethylmethacrylate (PMMA) injection was introduced by Galibert,et al,9) in 1987. Since the introduction of this procedure, many authors have reported that vertebroplasty results in firmative vertebral deformity correction and relief of back pain 1,2,[6][7][8]10,12) . However, the vertebroplasty has not been completely satisfactory because of potent complications such as the leakage of the bone cements into the spinal canal, minimal reduction of the kyphotic posture, and some rare cases of pulmonary embolism 2,20) .…”

Section: Introductionmentioning

confidence: 99%

Segmental Deformity Correction after Balloon Kyphoplasty in the Osteoporotic Vertebral Compression Fracture

Lee

Kwon

Kim

et al. 2007

J Korean Neurosurg Soc

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Percutaneous vertebroplasty with acrylic cement in the treatment of osteoporotic vertebral crush fracture syndrome

Cited by 38 publications

References 4 publications

CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients

Segmental Deformity Correction after Balloon Kyphoplasty in the Osteoporotic Vertebral Compression Fracture

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