Vertebroplasty in the treatment of osteoporotic vertebral body fracture

Abstract

During the last few years, vertebroplasty has gained a wide acceptance for the treatment of painful osteoporotic vertebral body fractures and osteolytic changes. However, new guidelines with significant changes in indications and technique were published recently in Europe. Therefore, the aim of this review is to highlight recent changes in indications for vertebroplasty, patient work-up and changes in procedural technique, and to give an overview of patient outcome and possible complications. Therefore, technical details like different types of fluoroscopy, needle placement, pain management during the intervention, recommended equipment, including bone cement, and the use of venography are discussed. Postprocedural issues are noted, including the risk of minor and major complications and the expected outcome of the treated patients.

Percutaneous vertebroplasty: optimizing the procedure after treatment of 250 vertebral levels under fluoroscopic guidance

“…PVP is today considered to be a safe and effective minimally invasive technique for treating symptomatic vertebral fractures refractory to conservative medical treatment and is characterised by an extremely low risk of complications. Severe complications have been reported [12,13], but most studies agree that these outcomes can be minimised with the use of high-quality radiological guidance systems and by performing the procedure in an angiography suite where the fluoroscopy equipment is better, rather than in an operating theatre where the most severe complications have been reported due to the inferior quality of the C-arm device [1,2,9,[13][14][15][16]. PVP can be performed as a day-surgery procedure with significant reductions in hospital costs, and it has proved to be a rapid and easily performed technique in expert hands.…”

“…La VPP oggigiorno è considerata una tecnica mininvasiva sicura ed efficace per il trattamento delle fratture vertebrali sintomatiche non responsive alla terapia medica conservativa ed è caratterizzata da un rischio di complicanze estremamente basso. Complicanze gravi sono riportate [12,13], ma la maggior parte degli studi è concorde sul fatto che tali evenienze possono essere ridotte al minimo utilizzando sistemi radiologici di guida di elevata qualità ed eseguendo le procedure in una sala angiografica, dove l'apparecchiatura fluoroscopica è migliore, piuttosto che in una sala operatoria dove sono riportate le complicanze più gravi a causa della qualità inferiore del tubo a "C" [1,2,9,[13][14][15][16]. La VPP può essere eseguita in regime di day-surgery con significativo contenimento dei costi ospedalieri, e si dimostra essere una tecnica rapida e facile in mani esperte.…”

Future directions in percutaneous vertebroplasty

“…First used by Galibert et al in 1984 as vertebroplasty, the procedure was successfully applied to the treatment of C2 aggressive haemangiomas [7] and subsequently used on VCF secondary to osteoporosis and osteolytic tumours [8][9][10][11].…”

“…Questa procedura, utilizzata per la prima volta da Galibert et al nel 1984 per il trattamento di un angioma aggressivo di C2 [7] e denominata vertebroplastica, è attualmente utilizzata con successo nel trattamento delle VCF secondarie ad osteoporosi o tumori osteolitici [8][9][10][11].…”

Height gain of vertebral bodies and stabilization of vertebral geometry over one year after vertebroplasty of osteoporotic vertebral fractures

“…Percutaneous vertebroplasty is a minimally invasive procedure that was developed in the 1980s. It has become widely established and has been shown to impressively reduce pain in osteoporotic vertebral fractures, improve quality of life, and reduce the hospital stay compared with conservative treatment [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The primary goal of vertebroplasty is pain relief [11] and stabilization of the vertebral body.…”