Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results

Abstract

Vertebroplasty-percutaneous cement augmentation of osteoporotic vertebrae is an efficient procedure for the treatment of painful vertebral fractures. From a prospectively monitored series of 70 patients with 193 augmented vertebrae for osteoporotic and metastatic lesions, we analysed a group of 17 patients suffering from back pain due to osteoporotic fractures. The reinforcement of 45 vertebral bodies in these patients led to a significant and lasting pain reduction (P < 0.01 ). The presented technique is useful, as, in one session, at least four injections can be performed when required, allowing the prophylactic reinforcement of adjacent vertebrae as well. The use of a low-viscosity polymethyl methacrylate (PMMA) in combination with a non-ionic liquid contrast dye provides a reliable and safe procedure. Extraosseous cement leakage was seen in 20% of the interventions; however, none of them had clinical sequelae.

Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis

“…In addition to the cause of the leakage, the differing cement leakage measurements influenced the results. Heini et al [16] provided further evidence that little cement leakage is found by standard X-ray imaging, whereas high rates are observed with computed tomography. Therefore, the GRADE evidence quality for cement leakage was very low because of the high risk of publication bias and outcome inconsistencies.…”

“…Belkoff et al [3,4] provided evidence of pain reduction that was attributable to immobility and inhibition of micromovement in the fractured fragment. In addition, a cytotoxic effect of polymethylmethacrylate (PMAA) causes damage to terminal nerve endings and contributes to pain reduction [16]. However, Togawa et al [46] reported that PMAA did not influence the thermic pain reduction effect.…”

“…Severe complications occur in up to 8 % of the KP and VP patients [16]. However, cement leakage does not usually cause any clinical symptoms.…”

“…The MINORS quality scores of the nonRCTs are presented in Table 1. The mean score was 12.8 (range, [8][9][10][11][12][13][14][15][16], which corresponded to a 53 % score. This result indicated that there was considerable variability in the evidence base.…”

Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases

“…Since then, indications were extended to spinal column metastatic lesions, myelomas and acute vertebral fractures. During the past decades there has been adequate evidence in support of its safety, immediate pain reduction effectiveness exceeds 90% of cases and biomechanical stability [17][18][19][20][21]. Anyway, patient selection criteria and precise indications about timing of treatment for osteoporotic vertebral fractures have not been established yet.…”