Percutaneous Vertebroplasty

Abstract

This review, aimed at current practitioners of vertebroplasty, highlights recent changes in patient work-up and procedural techniques that have streamlined the authors' clinical practice. Preprocedural work-up, including history, physical examination, and adjunctive imaging techniques, are discussed. Technical details are reviewed, including types of equipment, techniques of needle placement, and utility of venography. Postprocedural issues are noted, including risk of subsequent fracture after vertebroplasty, long-term outcome of cement in the vertebral body, and utility of prophylactic vertebroplasty. Finally, the current state of evidence in support of the efficacy of vertebroplasty are discussed, with particular attention to the need for ongoing clinical trials.

Percutaneous vertebroplasty: the follow-up

“…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].…”

“…Further imaging with CT helped identify sites of potential cement leakage, as in posterior wall discontinuity [3,5].…”

“…Bed rest was recommended for at least 7-8 h. Where medical conditions permitted, patients were discharged the following day after a final assessment. [3,5]. A total of 173 vertebral bodies were treated, distributed as follows: T5 (4), T6 (4), T7 (4), T8 (6), T9 (7), T10 (10), T11 (23), T12 (27), L1 (36), L2 (20), L3 (16), L4 (14), L5 (2).…”

Improvement of intertrochanteric bone quality in osteoporotic female rats after injection of polylactic acid-polyglycolic acid copolymer/collagen type I microspheres combined with bone mesenchymal stem cells

“…However, polymethyl methacrylate (PMMA), the most widely used material in these operations, is non-biodegradable and thus can impair bone remodelling, resulting in decreased mechanical strength of the vertebral body [1,2]. For osteoporotic patients with no fractures, such operations are not suitable [3]. As the need for bone fracture repair is currently one of the major concerns in reconstructive surgery in elderly patients [4], we hope to find a biodegradable material which can promote bone remodelling and quality in the treatment and/or prevention of fractures in osteoporotic patients.…”

Vertebroplasty: What Is Important and What Is Not

“…Among these is the potential for the procedure itself to increase the risk for new VCFs in untreated vertebral bodies at other levels. [8][9][10][11][12] Such fractures have been reported within a year following vertebroplasty, 10 with subsequent new VCFs adjacent to the primary VCF occurring earlier than those nonadjacent to the primary VCF. 11 Although the cause is not understood, it has been proposed that the subsequent new VCFs adjacent to the primary VCF may be caused by the augmented stiffness of the treated vertebrae as a result of the amount of cement injected or as a result of cement leakage in the adjacent vertebral disk space.…”