Abstract No. 470 - Posterior fragment encasement vertebroplasty in cord-level burst fractures

Abstract

No. 469 Salvage vertebroplasty after failed kyphoplasty R. Florek, C. Simonson; Radiology, Lourdes Regional Medical Center, Lafayette, LA; Radiology, West Jefferson Medical Center, Marrero, LA Purpose: Review the technique and theraputic benefit of vertebroplasty after unsuccesssful kyphoplasty for pain control in vertebral compression fractures. Materials and Methods: Three cases were reviewed in which kyphoplasty was unsuccessful in relieving back pain due to osteoporotic vertebral compression fractures. Two cases were at one level and one case had two levels, all were lumbar. After CT review, verteboplasty was elected to be done to increase the distribution of bone cement (polymethylmethacrylate PMMA) around the kyphoplasty balloon cavity spheres. Using realtime biplane fluoroscopy, the vertebroplasty bone cement was seen to track beyond the previous kyphoplasty cement balls and tracted into the vertebral fracture clefts. Less than 1.5 cc of PMMA bone cement was used at each level. Follow-up CT scans showed bone cement in the anterior vertebral fracture clefts. Results: All three patients experienced significant pain relief after vertebroplasty and no further procedures were needed. No new fractures were detected. No complications were encountered. Conclusion: 1. Kyphoplasty bone cement fills the cavity made by the inflation of a balloon in the vertebral body, but may not always enter the fracture cleft. 2. Re-do procedure with vertebroplasty injection of bone cement may be able to alleviate pain by entering the anterior fracture cleft and stabilizing the fracture site.