Percutaneous Injection Of Polymethylmethacrylate Research Articles

Percutaneous Cement Injection for the Palliative Treatment of Osseous Metastases: A Technical Review.

The technical art to percutaneous injection of polymethyl methacrylate (PMMA) cement for the palliative treatment of osseous metastases is not without pitfalls. Pathologic fracture, cortical bone erosion, large lytic tumor, aggressive tumor biology, and tumor vascularity may increase the risk of cement leakage or limit complete consolidation. A calculated and determined approach is often necessary to achieve satisfactory patient-tailored results. This article reviews the challenges and potential complications during the consolidation of osseous metastases. Case examples are presented to facilitate early detection of impending cement leakage, minimize procedural risks, and provide management suggestions for complications. Technical pearls are provided to refine consolidative techniques and improve the comprehensive treatment of painful osseous metastases.

Prise en charge thérapeutique des métastases osseuses en radiologie interventionnelle

A wide range of interventional radiology methods is currently available for the management of bone metastasis disease. Indications should be discussed in pluridisciplinary staff, depending of therapeutic intent (curative or palliative), risk of fracture, and general status of the patient. The aim of this article is to present these techniques. Cementoplasty, defined by percutaneous injection of polymethylmethacrylate into bone metastases, is used to relieve pain and prevent pathological fractures. Thermal ablation techniques are applied to achieve partial or complete destruction of bone lesions, by increasing (radiofrequency and micro-waves) or decreasing (cryoablation) intratumoral temperature. Arterial embolization and chemoembolization are used to reduce blood supply of bone tumors, in order to manage pain or before orthopedic surgery of hypervascular lesions. For the most complexes cases, combined treatment can be proposed.

Percutaneous Injection of Polymethyl Methacrylate for the Treatment of Osteoarthritic Knee Pain Caused by Bone Marrow Edema: A Case Report and Review of Literature

Osteoarthritis is a common disease that affects the elderly peoples, with a detrimental effect on quality of life as a result of pain, and total joint replacement is usually the last option for end-stage osteoarthritis. However, for those whom have complex diseases, total joint replacement was limited. Thus, looking for an alternative way to relieve pain is necessary. Recently, bone marrow edema is has been demonstrated to associate with knee pain and osteoarthritis. Thus, targeting bone marrow edema may provide a promising approach for relieving knee pain and delayed osteoarthritis development and progression. The present study highlights the importance of bone marrow edema to recurrent knee pain, and demonstrates an alternative way for treating patients who have osteoarthritic knee pain caused by bone marrow edema, and are not suitable for total knee replacement as a result of contraindications such as multiple internal diseases and high risk of operation.

Unilateral or bilateral percutaneous vertebroplasty for acute osteoporotic vertebral fracture: a prospective study.

Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of acute osteoporotic vertebral fracture (AOVF). However, the matter of which surgical approach should be selected remains controversial. This research aims to compare the clinical results of unilateral and bilateral PVP for AOVF. From January 2008 to December 2011, 68 patients with AOVF were randomly assigned to the unilateral puncture group (n=36) or the bilateral group (n=32). These patients underwent percutaneous injection of polymethyl methacrylate into posterior pedicle by the unilateral or bilateral puncture approach. Visual analogue scale (VAS) and the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) were recorded on presentation, at 1 week, 3, 6, and 12 months after operation. The cement leakage was measured by x-ray and computed tomography scan. Follow-up data showed there were no significant differences in VAS and QUALEFFO between 2 groups at 1 week after PVP and only significant difference was observed between 2 groups at 3, 6, and 12 months after operation. The cement leakage was 52.7% in the unilateral puncture group and 28.1% in the bilateral group. Compared with unilateral puncture, use of bilateral approach during PVP may result in more superior long-term outcomes and less cement leakage for patients with AOVF.

Occlusion of an Intraosseous Arteriovenous Malformation With Percutaneous Injection of Polymethylmethacrylate

Primary intraosseous arteriovenous malformations are rare. Many minimally invasive procedures can be considered preoperative steps and/or definitive treatment. The case reported regards a young woman with a voluminous arteriovenous extratroncular infiltrating malformation of the humerus. She underwent several treatments, but none of them was completely occlusive. The last treatment consisted of direct percutaneous puncture of the intraosseous alteration and injection of polymethylmethacrylate (PMMA), which is normally used in percutaneous vertebroplasty. We obtained complete occlusion of the humerus lytic lesion. To the best of our knowledge, this represents the first case of intraosseous AVM treated by percutaneous injection of PMMA.

Use of percutaneous kyphoplasty to treat painful vertebral compression fractures (VCF) in solid tumors

e20568 Background: Vertebral compression fractures are a major source of morbidity in metastatic carcinoma. Kyphoplasty involves inflation of a balloon for painful kyphotic deformity restoring the vertebral body to its original height and creating a cavity for percutaneous injection of polymethylmethacrylate (PMMA). Contraindications include epidural spinal cord compression. Although it is FDA approved for cancer-associated VCF most of the data is in the myeloma population. Methods: We retrospectively assessed by electronic medical records the safety and efficacy of kyphoplasties performed by the orthopedic spine service in a single institution between 12/03 and 2/08. We identified those patients who had kyphoplasty as the only spine procedure and excluded those patients with incomplete documentation of pain scores. Comparison was made between patients selected for pathologic compression fractures and benign compression fractures secondary to trauma or osteoporosis. Results: Review of 447 consecutive orthopedic spine cases identified 40 kyphoplasty patients, 30 of which met the inclusion criteria - 21 with benign compression fractures secondary to osteoporosis/trauma and 9 with malignant disease (3 breast CA, 2 lung, 1 cervix, 1 RCC, 2 myeloma). 49 kyphoplasties and 23 concurrent spine biopsies were performed in this group. Median age was in the cancer group was 55 (37–81) vs. 68(41–93) in benign group. One patient had prior radiation in the cancer group. The average preoperative visual analog pain score was 7 (range 3–9) and postoperative pain score was 2.0 (0–9) in the cancer group. The average preoperative visual analog pain score 6.8 (0–9) and post-operative score was 0.8 (0–4) in the benign group. Most procedures did not require general anesthesia. There were no reported PMMA extravasations, and no hematologic or neurologic complications in either group. Conclusions: Kyphoplasty provided marked pain relief in patients with VCF secondary to solid tumors and myeloma. The results are comparable to non-cancer population in safety and efficacy, and are feasible in selected cancer patients with pain due to pathologic compression fractures. [Table: see text]

Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study

Background context Sacral insufficiency fractures (SIFs) can cause low back pain in osteoporotic patients. Symptomatic improvement may require up to 12 months. Treatment includes limited weightbearing and bed rest, oral analgesics, and sacral corsets. Significant mortality and morbidity are associated with pelvic insufficiency fractures. Percutaneous injection of polymethylmethacrylate (PMMA) into the fractured ala, sacroplasty, is an alternative treatment for SIF patients. Under fluoroscopic control, 13-G bone trochars are inserted into the fractured ala while the patient is maintained under conscious sedation. Initial reports have documented safe and effective performance of sacroplasty. Yet, these uncontrolled findings do not allow any precision in estimating complication rates or expected outcome. Purpose Assess rates of complications and observe outcomes after sacroplasty in a medium-sized uncontrolled cohort of SIF patients. Study design/setting A prospective observational cohort study of consecutive osteoporotic SIF patients. Patient sample Consecutive, osteoporotic patients with symptomatic SIFs electing to enter the study. Outcome measures Visual Analogue Scale (VAS) score, analgesic utilization, and patient satisfaction. Methods Baseline VAS rating, analgesic usage, and duration of symptoms were recorded. Subsequent VAS ratings were assessed within 30 minutes after the procedure, at 2-, 4-, 12-, 24-, and 52-week postprocedure. Analgesic usage and patient satisfaction were assessed at final follow-up. Each procedure was performed under light intravenous conscious sedation using fluoroscopy. Two bone trochars were inserted between the sacral foramen and sacroiliac joint through which 2 to 3 cc of PMMA were injected. Results Fifty-two patients, 40 females, were treated. The mean age was 75.9 years with a mean symptom duration of 34.5 days. All patients were available at each follow-up interval except one patient who died because of unrelated pulmonary disease before the 4-week follow-up. The mean VAS score at baseline was 8.1 and 3.4 within 30 minutes after the procedure, 2.5 at 2, 2.1 at 4, 1.7 at 12, 1.4 at 24, and 0.8 at 52 weeks. Improvement was statistically significant using a repeated measures single-factor analysis of variance. One case of transient S1 radiculitis occurred but resolved completely with one transforaminal epidural steroid injection. Conclusions Sacroplasty for SIF appears to be associated with rapid and sustained pain relief in most patients with few complications. More rigorous trials are warranted to provide definitive evidence of the safety and efficacy of sacroplasty for SIFs.

Percutaneous Vertebroplasty for Osteoporotic Fractures

Background: Vertebral augmentation has been widely used to treat vertebral body compression fractures caused by varied pathologies. The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men, and exponential increase of osteoporotic fractures worldwide. Purpose: To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with osteoporotic vertebral fractures. Design: A prospective study. Materials and Methods: A prospective evaluation of pain relief in 30 patients, with mean age of 73.7 years, who underwent percutaneous injection of polymethyl methacrylate into 54 vertebrae under fluoroscopic guidance over a period of 35 months was done. Before the procedure and at follow up, patients were asked to quantify their pain on a visual analogue scale. Results: The procedure was technically successful in all the patients. Mean duration of follow up was 21.5 months (6-44months). Ninety-seven percent of the patients reported a significant relief 24 hours after the procedure. Ninety-two percent reported significant improvement in back pain, previously associated with a compression fracture, as well as improved ambulatory ability. Before vertebroplasty, the VAS score was 8.91+/- 1.82 compared to a score of 2.02+/- 1.95 at follow up. The mean difference in VAS score was significant (p<.0001). One patient had an asymptomatic epidural leak of PMMA, however did not require any further intervention. Conclusion: Percutaneous vertebroplasty of symptomatic osteoporotic vertebral compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain. Key words: Compression fracture, osteoporosis; pain, vertebroplasty, polymethylmethacrylate

Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures

The injection of polymethylmethacrylate (PMMA) is a minimally invasive image-guided procedure that is typically used to treat vertebral body fractures due to osteoporosis or neoplastic involvement. The injection of PMMA into various other locations including the sacrum, acetabulum, pedicles, femur and tibia has been reported previously, and these procedures have, overall, been highly effective at alleviating pain and discomfort. Although the injection of PMMA into the vertebral body is a very common procedure that has been performed for over 2 decades for the percutaneous treatment of vertebral body fractures, the percutaneous injection of PMMA has not been reported in the English literature as treatment for superior pubic ramus fractures. We report the percutaneous treatment of an acute superior pubic ramus fracture and of a chronic insufficiency fracture of the superior pubic ramus using a parasymphyseal approach to access the region of injury.

Percutaneous vertebroplasty and/or kyphoplasty is an effective and safe treatment for painful vertebral compression fractures in multiple myeloma (MM)

7610 Background: Painful vertebral compression fractures are a major source of morbidity in MM. Vertebroplasty involves percutaneous injection of polymethylmethacrylate (PMMA) into a vertebral body, while kyphoplasty involves inflation of a balloon for painful kyphotic deformity prior to stabilization with PMMA. Methods: We assessed safety and efficacy of 100 vertebroplasties and/or kyphoplasties in 81 consecutive myeloma patients between 12/2000 and 2/2005. Results: Median age was 63 (range 32–84), with 29% having prior radiotherapy to the vertebra treated. Contraindications included epidural compression of neural elements and failure to localize a symptomatic level. Kyphoplasty was preferred if kyphosis of > 20 degrees contributed to pain, or if the posterior vertebral cortex was disrupted so that controlled delivery of bone cement was difficult. Vertebroplasty was performed when vertebral collapse was either slight or so severe that insertion of balloon device was not possible, or if patient could not tolerate the general anesthesia required for kyphoplasty. The median preoperative visual analog pain score (0–10) was 8(range 2–10); the median postoperative pain score was 3 (range 0–10) (p < 0.01). There were no significant complications . Conclusions: Percutaneous vertebroplasty and kyphoplasty provided rapid and marked pain relief. These procedures are safe and feasible and represent the treatment of choice in selected MM patients with severe refractory pain due to pathologic compression fractures. No significant financial relationships to disclose.

Percutaneous Vertebroplasty in a Broken Vertebral Titanium Implant (Titanium Mesh Cage)

We report the case of a percutaneous consolidation of a broken vertebral implant (Surgical Titanium Mesh Implants; DePuy Spine, Raynham, MA, USA) by vertebroplasty. Four years after anterior spondylectomy with cage implantation and stabilization with posterior instrumentation, the patient was admitted for excruciating back pain. Radiographs showed fracture of the cage, screw, and rod. An anterior surgical approach was deemed difficult and a percutaneous injection of polymethyl methacrylate into the cage was performed following posterior instrumentation replacement. This seems to be an interesting alternative to the classical anterior surgical approach, which is often difficult in postoperative conditions.

Numerous Bilateral Radiographically Dense Branching Opacities after Vertebroplasty with Polymethylmethacrylate

Percutaneous vertebroplasty consists of the percutaneous injection of polymethylmethacrylate (PMMA) cement into a collapsed vertebral body in order to obtain pain relief and mechanically strengthen the vertebral body. This procedure is now extensively used in treating osteoporotic vertebral compression fracture. It is an efficient treatment, but it is not free of complications. Most complications after vertebroplasty are associated with PMMA leakage. Pulmonary embolism of PMMA is rare, but this can occur when there is a failure to recognize venous migration of cement early during the procedure. We encountered a case of a patient with asymptomatic pulmonary embolism because of PMMA after percutaneous vertebroplasty. Chest X-ray and CT scanning revealed numerous tubular branching opacities that corresponded to the pulmonary vessels at the segmental and subsegmental levels. (Tuberc Respir Dis 2006; 61: 184-188)

Percutaneous vertebroplasty

Percutaneous vertebroplasty is a safe and successful method for the treatment of vertebral lesions due to osteoporotic fractures, metastatic lesions or haemangiomas. The procedure involves the percutaneous injection of polymethyl methacrylate (PMMA) into a pathological vertebral body. The technique is described in detail together with potential complications. Strict adherence to selection criteria, a multidisciplinary approach and the need for excellent imaging equipment are stressed.

Biomechanical evaluation of vertebroplasty using injectable calcium phosphate cement

Biomechanical evaluation of vertebroplasty using injectable calcium phosphate cement

Predictive Value of Intraosseous Venography before Percutaneous Vertebroplasty

Percutaneous vertebroplasty is a novel approach for treating patients with painful vertebral body compression fractures. The use of intraosseous venography before the percutaneous injection of polymethylmethacrylate (PMMA) is not universally accepted. The purpose of this study was to determine if intraosseous venography predicts PMMA flow characteristics when injected into a vertebral body. One hundred thirty-five intraosseous venograms were obtained during 96 vertebroplasty procedures (39 thoracic, 57 lumbar) in 61 patients (49 women, 12 men; age, 36-94 y) over a 32-month period. All venograms were obtained by injecting water-soluble contrast material through the vertebroplasty needle that had been placed percutaneously via a transpedicular approach. The venograms were retrospectively reviewed by the authors and compared in a blinded fashion with the subsequent final vertebroplasty result. Several venographic patterns were observed: bilateral or unilateral marrow blush with or without venous filling, direct venous filling, leakage of contrast material through an endplate or cortical defect, and stasis within the marrow space. Venograms that demonstrated a bilateral marrow blush predicted flow of PMMA across the midline to adequately fill the contralateral hemivertebrae 95% of the time (40 of 42 cases). A unilateral marrow blush predicted the necessity of a second puncture 97% of the time (32 of 33 cases). Intraosseous venography predicted PMMA entering endplate/cortical defects in all cases (22 of 22) and venous structures in 29% (22 of 75) of cases. Direct venous filling was observed during two vertebroplasty procedures and gelatin foam embolization was performed before PMMA instillation. Stasis of contrast material in the marrow space was observed in 15 cases. Overall, in 83% (80 of 96) of the vertebroplasty procedures, intraosseous venography was believed to predict the flow characteristics of PMMA. Intraosseous venography provides useful information in predicting PMMA flow characteristics within the vertebral body and in predicting potential undesirable sites of cement deposition, such as through cortical defects and within venous structures.

Percutaneous transpedicular vertebroplasty for treatment of osteoporosis-induced vertebral fractures

Osteoporosis plays an increasing medical, social, and economic role in our society. Vertebral body fractures are the most common fractures, along with fractures around the hip joint, and fractures of the distal radius due to osteoporosis. An osteoporotic vertebral compression fracture can lead to incapacitating back pain and immobility and often requires in-hospital treatment. Vertebroplasty is an effective procedure consisting of the percutaneous injection of polymethylmethacrylate (PMMA) cement into vertebral bodies. Preliminary studies showed promising clinical results with this new technique. As there is a high incidence of cement leakage during the injection of the cement, we prefer to perform the procedure under computed tomography control with a fluoro-CT-option. Furthermore, we recommend that the procedure is only done in collaboration with a spine surgeon. In case of a neurological complication, immediate decompression of the spinal canal is mandatory. Vertebroplasty is a very promising, effective and safe method for the treatment for osteoporotic vertebral compression fractures. Based on our preliminary results, this method can be recommended for a more widespread clinical use.