Percutaneous Vertebroplasty in Vertebral Body Compression Fracture

Abstract

Background: Percutaneous vertebroplasty is increasingly used to treat osteoporotic vertebral fractures. This study was designed to identify the clinical efficacy and complications of percutaneous vertebroplasty performed in cases with medically intractable pain due to a vertebral compression fracture. Methods: One hundred and twenty-eight patients (39 men 89 women) underwent 152 percutaneous vertebroplasties under fluoroscopy. For accurate diagnoses, all patients undertook a simple X-ray, bone scan and MRI before the procedure. To evaluate leakage during the procedure, a post-procedural CT scan and simple X-ray were obtained. To assess the clinical efficacy after the procedure, the time required for the relief of pain and ambulation without significant pain were evaluated. Results: Pain relief and early ambulation, without significant pain, were possible within 0 - 2 days, with means of 0.62 and 1.23 days, respectively. Post-procedural CT scans and simple X-rays revealed leakage of the polymethylmethacrylate (PMMA) - barium mixture into the paravertebral tissue (n = 47), the paravertebral venous plexus (n = 36), epidural space (n = 4) and pulmonary embolism (n = 1) after the surgical procedures. Conclusions: Percutaneous vertebroplasty is an effective interventional procedure to treat a vertebral body compression fracture. The procedure relieves pain and provides for early mobilization. However, procedural related complications are not uncommon. Adequate preparation of the PMMA, an optimal needle tip point through venography and confirmation with biplane fluoroscopy are mandatory to minimize these complications.