Percutaneous Vertebroplasties Research Articles

RADIATION DOSES TO THE EYE LENS AND FOREHEAD OF INTERVENTIONAL RADIOLOGISTS: HOW HIGH AND ON WHAT GROUNDS?

The aim of the study was to measure and evaluate the radiation dose to the eye lens and forehead of interventional radiologists (IRs). The study included 96 procedures (lower-limb percutaneous transluminal angioplasties, embolisations/chemoembolisations and vertebroplasties) performed by 6 IRs. A set of seven thermoluminescence dosemeters was allocated to each physician. The highest dose per procedure was found for the left eye lens of the primary operator in vertebroplasties (1576μSv). Left and right eye doses were linearly correlated to left and right forehead doses, respectively. A workload-based estimation of the annual dose to participating IRs revealed that the occupational dose limit for the eye lens can be easily exceeded. The left eye dose of ΙRs must be routinely monitored on a personalised basis. Τhe left eye dose measurement provides a reliable assessment of the ipsilateral forehead dose, along with valid estimations for the right eye and right forehead doses.

Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty: a technical report

Background contextAbsence or inadequate filling of cement in the fractured vertebrae can cause unsatisfactory results in a vertebroplasty. Repeated needle insertion can reduce the incidence of recollapse at the cemented vertebrae. However, when inserting the second needle in the usual method, it takes the same time and radiation exposure as the first needle. PurposeTo report a Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty that can make the procedure simple, effective, and, most importantly, reduce the radiation exposure. Study designDescription of a modified surgical technique with retrospective data analysis. Patient sampleFrom January 2012 to December 2012, 87 percutaneous vertebroplasties were performed in our department to treat painful osteoporotic compression fractures. Seven adult patients (five women, two men; mean age: 75.7 years) had inadequate cement filling in the treated vertebrae that required the insertion of a second needle. Outcome measuresBack pain was measured using the visual analog scale (VAS). The post-vertebroplasty anterior vertebral height and local kyphotic angle were used as the radiologic parameters. Intraoperative procedure time and fluoroscopy shots and postoperative complication were also evaluated. MethodsThe stylus of the first needle was inserted into the trocar to push the cement out of the trocar. The stylus was removed, a small diameter K-wire was inserted into the trocar, and the trocar was then removed. A second (new) trocar was inserted into the vertebral body following the track of the K-wire. When the new trocar reached the posterior 1/4 of the vertebral body, the K-wire was removed, the stylus was inserted, and the new needle was advanced to the anterior third of the vertebra. Cement was then injected into the new area until the filling was adequate. ResultsThe immediate post-vertebroplasty anterior vertebral height was 23.31±1.95 mm, changed to 22.20±3.72 mm at final follow-up. The VAS decreased from a mean of 8.4 before vertebroplasty to 1.6 at the final follow-up. The follow-up duration ranged from 6 to 15 months (mean 12.6 months). There was no case of recollapse of the cemented vertebrae and no procedure-related complications. The procedure time of historical controls was 153.5 seconds, which reduced to 47.9 seconds by using this technique. The fluoroscopy shots of historical controls were 9.7 shots, which reduced to 2 shots by using this technique. ConclusionsThis report suggests that Kirschner wire-guided technique for inserting a second needle during vertebroplasty could make the procedure simple, effective, and, most importantly, reduce the procedure time and radiation exposure.

Percutaneous vertebroplasty: a comparison between the procedure using the traditional and the new side-opening cannula for osteoporotic vertebral fracture

A total of 47 percutaneous vertebroplasties (PVs) were performed for osteoporotic vertebral fractures in 31 patients, 25 PVs were performed using the frontal-opening cannula (FOC) and 22 using the new side-opening cannula (SOC), randomly distributed. The incidence of cement extrusion was 27% with the SOC, and 68% with the FOC, all asymptomatic (p<0.01). The pain control was similar for both groups, with good improvement of pain in most of the patients, and there were no clinical relevant complications. The cement leakage can be significantly reduced with this new SOC, which allows for a better cement injection toward the center of the vertebral body, increasing the safety of the procedure, with no increase in cost.

The efficacy of percutaneous vertebroplasty for palliation of pain in vertebral metastases associated with solid malignancies

e20670 Background: Painful vertebral metastases are a debilitating and common complication of a number of solid malignancies. Percutaneous vertebroplasty appears beneficial for patients with acute compression fractures of multiple aetiologies including myeloma, and osteoporosis. There are few reports on its use in the setting of metastatic solid malignancy. Methods: We identified all individuals who had undergone percutaneous vertebroplasty at our institution since 2004 and focused on those with metastatic solid malignancies. Their clinical characteristics and outcomes were investigated. Results: From 136 cases that underwent percutaneous vertebroplasties, 19 were performed mainly in breast, prostate, lung, and renal cancers. Of these 19 cases, ten patients (53%) were treated for solitary lesions, 3 (16%) were injected at two levels and the remaining 6 cases (31%) underwent cement injection at three levels. The majority of patients (84%) reported short (within 48 hours) and longer term symptomatic improvements. At a median follow up of one year, 6 patients have died. Conclusions: This study illustrates that percutaneous vertebroplasty can be a safe and beneficial palliative procedure for patients with pain related to metastatic vertebral disease. Up to three vertebral levels maybe injected at one sitting with good results. Its use can be successfully combined with other treatment modalities (radiotherapy and chemotherapy). For optimal results its use before radiotherapy has been recommended. Although it does not improve the survival outcome, palliation is a reasonable goal when life expectancy is short. Cost benefits from this procedure will come from reduced analgesic requirements and avoided complications of long-term bed rest, with significant potential savings from reduced in-patient admissions for pain control, home care costs, community nursing, and out-of ours access to clinical services. No significant financial relationships to disclose.

The efficacy of percutaneous vertebroplasty for vertebral metastases associated with solid malignancies

Background Percutaneous vertebroplasty appears beneficial for patients with acute compression fractures of multiple aetiologies including myeloma, osteoporosis and trauma. There are few reports on its use in the setting of metastatic solid malignancy. Methods We identified all individuals who had undergone percutaneous vertebroplasty at our institution since 2004 and focused on those with metastatic solid malignancies. Their clinical characteristics and outcomes were investigated. Results From 136 cases that underwent percutaneous vertebroplasties, 19 were performed mainly in breast, prostate, lung and renal cancers. Of these 19 cases, 10 patients (53%) were treated for solitary lesions, 3 (16%) were injected at two levels and the remaining 6 cases (31%) underwent cement injection at three levels. The majority of individuals (84%) reported short- and long-term symptomatic improvements. At a median follow-up of one year, six patients have died. Conclusions Percutaneous vertebroplasty appears as an effective palliative procedure in patients with compression fractures secondary to metastatic solid malignancy. Its use can be successfully combined with other treatment modalities (radiotherapy and chemotherapy).

Intraosseous Venography with Carbon Dioxide in Percutaneous Vertebroplasty: Carbon Dioxide Retention in Renal Veins

The objective of the present study was to determine the frequency of gas retention in the renal vein following carbon dioxide intraosseous venography in the prone position and, while citing references, to examine its onset mechanisms. All percutaneous vertebroplasties performed at our hospital from January to December 2005 were registered and retrospectively analyzed. Of 43 registered procedures treating 79 vertebrae, 28 procedures treating 54 vertebrae were analyzed. Vertebral intraosseous venography was performed using carbon dioxide as a contrast agent in all percutaneous vertebroplasty procedures. In preoperative and postoperative vertebral CT, gas retention in the renal vein and other areas was assessed. Preoperative CT did not show gas retention (0/28 procedures; 0%). Postoperative CT confirmed gas retention in the renal vein in 10 of the 28 procedures (35.7%). Gas retention was seen in the right renal vein in 8 procedures (28.6%), in the left renal vein in 5 procedures (17.9%), in the left and right renal veins in 3 procedures (10.7%), in vertebrae in 22 procedures (78.6%), in the soft tissue around vertebrae in 14 procedures (50.0%), in the spinal canal in 12 procedures (42.9%), and in the subcutaneous tissue in 5 procedures (17.9%). In conclusion, in our study, carbon dioxide gas injected into the vertebra frequently reached and remained in the renal vein.

Radiopaque thrombus in right ventricle

A 75-year-old woman presented with mild dyspnoea over 3 months. Nine months before she had been treated for pneumonia associated with septicaemia in an intensive care setting. Percutaneous vertebroplasties had been performed following osteoporotic fractures of several vertebrae 5 months earlier. Transthoracic echocardiography displayed a thready foreign body in the right ventricle reaching the right …

Percutaneous vertebroplasty in patients with osteoportic vertebral body fractures

Percutaneous vertebroplasty in patients with osteoportic vertebral body fractures

Pulmonary cement embolism: a complication of percutaneous vertebroplasty

Percutaneous vertebroplasty (PV) has recently become a very common procedure for vertebral compression fractures. Extravasation of cement, a common event associated with vertebroplasty, may lead to cement emboli in the lungs. To determine the frequency of pulmonary cement embolism after percutaneous vertebroplasty. Between 2002 and 2006, 128 percutaneous vertebroplasties were performed in 73 patients (56 women and 17 men) in our institution. Postprocedural chest radiographs were obtained for all patients and assessed for the presence of pulmonary cement emboli. Pulmonary cement embolism was detected on chest radiographs and confirmed with chest computed tomography (CT) in four patients treated with percutaneous vertebroplasty for osteoporotic collapse and one patient treated for multiple myeloma. The imaging finding of pulmonary cement embolism was solitary or multiple fine radiodense lines with occasional branching patterns. The frequency of pulmonary cement embolism was 6.8%. An incidence of pulmonary cement embolism of 6.8% during PV was found. Close clinical follow-up, postprocedural chest radiographs, and chest CT scans, if necessary, are important for the detection of pulmonary cement embolism at an early stage.

OUTCOMES OF VERTEBROPLASTY FOR TREATMENT OF PATHOLOGIC VERTEBRAL FRACTURES AND HAEMANGIOMAS

Objective. To compare the intensity of pain-relieving effect of percutaneous vertebroplasty (PV) in patients with gemangiomas, osteoporotic vertebral fractures, and malignant metastases. Matherial and Methods. 210 percutaneous vertebroplasties (VP) were performed in 121 patients at the age of 18 to 87 years. Out of them 22 patients had metastases into vertebral body/bodies, 72 patients – osteoporotic fractures, and 27 patients – vertebral haemangiomas with high-grade pain syndrome. The levels of vertebroplasty were between T3 and S1, predominantly (178 cases) from T9 to L4 levels. Significant anatomic abnormalities in seven cases required CT-guidance of the percutaneous vertebroplasty. Pain syndrome intensity before and after PV was assessed by visualanalogue scale. Results. Percutaneous vertebroplasty resulted in significant pain relief in all patients. One hundred-and-one patients reported full satisfaction with treatment, 17 patients – partial satisfaction, and 3 patients were not satisfied. Vertebroplasty complicated by cement leakage into the spinal canal in two patients with multiple myeloma. One patient with osteoporotic fractures has developed L5 radiculopathy after four-level PV, which was eliminated in 5 days. Three patients had transient complications. Conclusion. The achieved results confirm a high painrelieving efficacy of percutaneous vertebroplasty. A choice of vertebroplasy technique depends on a nature of pathology and peculiarities of vertebral anatomy. Application of cement based on calcium phosphate, bioceramic and bone morphogenetic proteins improves the long-term outcomes of percutaneous vertebroplasty.

MR Predictors of Bone Cement Leakage in Percutaneous Vertebroplasty and Kyphoplasty for Painful Osteoporotic Vertebral Compression Fracture

Study design: Retrospective study Objectives: To determine MR findings that affect the bone cement leakage in patients with osteoporotic compressive fractures who are receiving percutaneous vertebroplasties and kyphoplasties. Materials and Methods: A retrospective review was conducted on 105 patients with 131 vertebrae treated by percutaneous vertebroplasties (group 1: 66 patients and 78 cases) and kyphoplasties (group 2: 39 patients and 53 cases) from October 2001 to October 2005. The study was performed to determine whether cement leakage was related to any of the following MR findings: level of injured vertebra, severity of anterior height loss, posterior cortical disruption, endplate disruption, presence of either vacuum or cystic portions, linear sclerosis that was low in signal intensity in T1 and T2-weighted images. Results: Bone cement leakage was detected in 51 (65.3%) of 78 treated vertebrae in group 1 and 18 (33.9%) of 53 treated vertebrae in group 2. There was a statistically significant difference between the incidences (p<0.05). Vertebral endplate disruption had a positive correlation in both groups (p<0.05). There was more cement leakage in group 1 (48.5%) than in group 2 (18.1%) in cases of endplate disruption (p<0.05). Vacuum or cystic change had negative correlations to bone cement leakage in group 1 (p<0.05). No other MR findings demonstrated a statistically significant correlation with bone cement leakage. Conclusion: On the MR findings, vertebral endplate disruption and vacuum or cystic change in fractured vertebrae demonstrated a significant correlation with bone cement leakage in group 1. There was relatively less cement leakage into the intervertebral spaces with kyphoplasties than with vertebroplasties in the cases of vertebral endplate disruption.

Radiation Exposure to Operators during Vertebroplasty

To measure the radiation received by physicians during percutaneous vertebroplasty with use of two types of injection devices with the interventional equipment guided by computed tomography (CT) and an angiographic/CT system. Twenty consecutive patients who underwent percutaneous vertebroplasty were included in this study. The patients were divided into two groups, the 1-mL syringe group and the bone cement injector group. Percutaneous vertebroplasties were performed with the IVR-CT system, which combines angiographic and CT equipment with a single fluoroscopy table. Radiation dose to operators was measured as equivalent dose penetrating at a 10-mm tissue depth with use of electronic personal dosimeters attached outside and inside lead aprons. Effective radiation dose (HE) was estimated based on the radiation dose outside the lead apron (Ha) and the radiation dose inside the lead apron (Hb). Differences between the groups in doses and fluoroscopic duration were analyzed. In the 1-mL syringe group and bone cement injector group, mean Ha measurements were 320.8 microSv and 116.2 microSv, respectively. Mean Hb measurements were 14.5 microSv versus 7.8 microSv and mean HE measurements were 48.2 microSv versus 19.7 microSv. Significant differences were found in Ha, Hb, and HE. However, duration of fluoroscopy did not differ significantly between groups. Radiation dose was relatively high for operators performing percutaneous vertebroplasty. The bone cement injector was useful in reducing the level of radiation exposure to operators during vertebroplasty.

MR Predictors of Bone Cement Leakage in Patients Receiving Percutaneous Vertebroplasty

Purpose: To identify MR predictors of bone cement leakage in patients receiving percutaneous vertebroplasty. Materials and Methods: Percutaneous vertebroplasties were performed in 45 vertebras (T7; one, T8; two, T10; two, T11; two, T12; eight, L1; fifteen, L2; eight, L3; five, L4; two) in 35 patients (age 52-83). The procedure was performed using an 11 G Jamshidi needle, which was inserted into the target by the bipedicular approach. Kyphoplasty, unilateral pedicular approach and extrapedicular approach cases were excluded. Shortly after the procedure, all patients underwent a noncontrast CT covering the vertebroplasty sites. A retrospective study was performed to determine whether cement leakage is related to any of following MR findings: presence of cortical disruption of the vertebral body, severity of body compression (proportion of abnormal to normal vertebral body volumes), bone cement amount, bone cement amount/severity of body compression ratio, proportion of low-signal area in a vertebral body on T1 weighted image, presence of either vacuum or cystic portion below a linear dark signal in a fractured vertebra, and the location of dark signal intensity line in a vertebral body. Logistic discrimination model stepwise method was used in the statistical analysis. Results: On post-vertebroplasty CT scan, bone cement leakage was detected in or around 29 vertebrae (64%), including 11 vertebrae (24%) where leakage was found in the epidural space or radial vein. No patients displayed any neurological symptoms or signs. The most frequent site of bone cement leakage was the anterior external vertebral venous plexus (49%). Endplate cortical bone disruption was related to an increased risk of intervertebral bone cement leakage (p

Predictors of Outcomes of Percutaneous Vertebroplasty for Osteoporotic Vertebral Fractures

Retrospective review of all percutaneous vertebroplasties performed in the authors' institution from November 1994 to June 2002. OBJECTIVE.: To determine the factors affecting the outcome of percutaneous vertebroplasty for the treatment of persistent painful osteoporotic fractures. Percutaneous vertebroplasty is an efficient procedure to treat pain due to osteoporotic vertebral fracture. However, the patient population that is most likely to benefit from this procedure is uncertain, and the inclusion and exclusion criteria for an ideal candidate have varied widely in the literature. A retrospective review of 278 percutaneous vertebroplasty procedures for osteoporotic fractures at 423 levels was performed. Sociodemographic, clinical, radiologic, and procedural data were analyzed as parameters for prognosis significance by univariate and multivariate analysis with logistic regression to estimate the strength of influence of each variable. The presence of two or less symptomatic vertebrae (P < 0.03), the American Society of Anesthesiologists status I (P < 0.001), the presence of signal changes on magnetic resonance imaging (P < 0001), and the collapse of the vertebral body less than 70% (P < 0.001) were assessed as parameters for prognostic significance. Multivariate analysis also showed a significant correlation between the American Society of Anesthesiologists score and height loss of the vertebral body and the final outcome. The presence of signal changes on magnetic resonance imaging showed the highest odds ratio adjusted. Appropriate patient selection is essential for achieving clinical success. Better results can be expected in patients with an American Society of Anesthesiologists score of I and when the level managed is confirmed by magnetic resonance imaging and the vertebral body height loss is less than 70%.

Percutaneous vertebroplasty: Technique and results in 192 procedures

Percutaneous vertebroplasty with acrylic cement (usually polymethylmethacrylate) consists of injecting cement into vertebral bodies weakened by osseous lesions. The objective of this procedure is to obtain an analgesic effect by mechanical stabilization in destructive lesions of the spine. The three major indications are aggressive vertebral hemangiomas, severe or refractory pain related to osteoporotic vertebral fractures, and malignant vertebral tumors. Complications are infrequent, but occur essentially in patients with vertebral malignant tumors. We present our experience with 148 patients that underwent 192 percutaneous PMMA vertebroplasties for the treatment of painful osteoporotic compression fractures (76 patients, 105 vertebral levels), hemangiomas (31 patients, 43 vertebral levels) and neoplasms (31 patients, 43 vertebral levels). In a vast majority of appropriately selected cases and especially in osteoporotic cases, vertebroplasty constitutes a relatively simple procedure with a very high rate of success.

Percutaneous Vertebroplasty in Vertebral Body Compression Fracture

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.

Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena.

This study was undertaken to determine the efficacy of percutaneous vertebroplasty in treating patients with painful compression fractures of the thoracic and lumbar vertebrae that contain intraosseous vacuum phenomena. Nineteen cases of painful vertebral compression fractures with intraosseous phenomena occurring in 18 patients (six men, 12 women; age range, 59-88 years; mean age, 75.5 years) were identified from 393 percutaneous vertebroplasties performed in 199 patients during 32 and a half months. All patients had osteoporosis, with severe vertebral compression to less than one third of the vertebral body height in 13 of 19 cases. Affected levels were T6 (n = 1), T8 (n = 2), T9 (n = 1), T11 (n = 1), T12 (n = 4), L1 (n = 5), L2 (n = 2), L3 (n = 1), L4 (n = 1), and L5 (n = 1). All cases had the typical intravertebral body vacuum cleft appearance on radiographs. Imaging and clinical features were analyzed. The mean volume of polymethyl methacrylate injected was 7.43 mL (range, 4.0-15.0 mL). Typically, the polymethyl methacrylate filled the intravertebral vacuum cleft. Complications during radiography consisted of minimal polymethyl methacrylate leakage into the adjacent disk (15/19 cases) and the paravertebral soft tissues (8/19 cases). No complications required surgical intervention. At clinical follow-up, pain relief was complete in eight patients (44.4%), partial in six patients (33.3%), and unchanged in four patients (22.2%). Percutaneous vertebroplasty is effective in the treatment of patients with painful vertebral compression fractures with intraosseous vacuum phenomena.

Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures.

To determine the efficacy of percutaneous vertebroplasty in treating severe vertebral body compression fractures, or vertebra plana, in patients with osteoporosis. In 155 patients, 310 percutaneous vertebroplasties were performed during 25 months and 15 days. Of these, 37 patients (27 women, 10 men; mean age, 73.6 years) underwent 48 vertebroplasties for severe osteoporotic vertebral body compression fractures. The fractures were defined as vertebrae that have collapsed to less than one-third of their original height. Imaging and clinical features were analyzed, including the extent of vertebral collapse, location of the involved vertebra, pattern of vertebral compression, volume of polymethylmethacrylate injected, vertebroplasty complications, and clinical outcome. Vertebral body collapse averaged 23% (range, 4.5%-33.0%) of the original height. Involved vertebrae were located from levels T5 to L5, with one-half affected at the thoracolumbar junction. Patterns of vertebral compression were divided into gibbus (31 of 48 or 65%), plana (13 of 48 or 27%), and H shape (four of 48 or 8%). The mean volume of the cement injected was 6.0 mL (range, 1.5-12.5 mL). Complications observed on radiographs included cement leakage to the adjacent disc (17 of 48 or 35%) and the paravertebral soft tissues (four of 48 or 8%). There were no major complications. At clinical follow-up (mean duration, 11 months and 3 days; range, 3-24 months), pain relief was complete in 14 (47%) of 30 patients, partial in 15 (50%), and unchanged in one (3%). No patient required surgery. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures is safe and effective and should not be withheld in this group of patients.

Unilateral transpedicular percutaneous vertebroplasty: initial experience.

To compare the radiographic and clinical outcomes of a unipediculate approach with those of standard bipediculate vertebroplasty. Retrospective review of percutaneous vertebroplasties yielded 18 vertebrae in 17 patients that were treated with a standard bipediculate approach and 57 vertebrae in 32 patients that were treated with a modified unipediculate approach. Anteroposterior radiographs obtained after the procedure were viewed to calculate the percentage of cement opacification in both vertebral halves, and mean values were compared between uni- and bipediculate approaches by using a two-tailed Student t test. Clinical outcomes, including pain relief and change in pain medication requirements, were compared in the two groups by using the chi(2) or Fisher exact test. With the unipediculate approach, filling across the midline was achieved in 55 (96%) of 57 injections. Mean opacification of vertebral body halves was 83% +/- 19 (SD) and 77% +/- 16 for the bipediculate and unipediculate approaches, respectively (P =.19). Among patients with available follow-up data, 16 (94%) of 17 patients who underwent the bipediculate procedure and 28 (88%) of 32 patients who underwent the unipediculate procedure achieved adequate pain relief (P =.65) with mean decreases in pain severity of 7.3 +/- 3.1 and 6.6 +/- 2.9, respectively. Use of a unipediculate approach in percutaneous vertebroplasty allows filling of both vertebral halves from a single puncture site with no statistically significant difference in clinical outcome from that of bipediculate vertebroplasty.

Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients.

The aim of this study was to determine the efficacy of percutaneous vertebroplasty in treating painful spinal osteoporotic collapse. Twenty-three cases of vertebral collapse were evaluated with CT and MR imaging to determine osteoporotic origin and recent evolution. Percutaneous vertebroplasties were performed using CT guidance. The 20 patients included in the study (17 women, 3 men; 62-92 years old) had acute pain of less than 1 month's duration that hindered ambulation and required treatment with narcotic drugs. They underwent this procedure for analgesic purposes. The analogic visual scale of Huskisson was used for pain when scoring assessment. In 15 patients (75%), pain relief was complete within 24 hr after injection. Analgesic administration was stopped in 14 patients. Mild pain persisted in three (15%) of the remaining five patients. In one other patient (5%), crural pain was observed with cement leakage in the psoas muscle. In the fifth patient (5%), pain recurred after the patient was lifted. The pain was related to a new acute collapse of an adjacent vertebrae. Vertebroplasty for the treatment of osteoporotic vertebral collapse is a minimally invasive procedure that provides immediate pain relief and enables the patient to become quickly mobile.