Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-05T12:57:27.002Z Has data issue: false hasContentIssue false

5 - Percutaneous Vertebroplasty

from PART I - LOCOREGIONAL PAIN CONTROL

Published online by Cambridge University Press:  04 September 2009

By
Mitchell T. Smith
Edited by
Charles E. Ray, Jr.
Charles E. Ray, Jr.
Affiliation:
Denver Health Medical Center
Get access

Summary

INTRODUCTION

The first percutaneous vertebroplasty (PVP) using imaging guidance was performed in France in 1984 (1). The injection of polymethylmethacrylate (PMMA) by Galibert et al. into a painful C2 hemangioma relieved the patient's pain (1). Since that time, the interest and technical efficacy have improved to the point where PVP is used to treat osteoporotic and malignant compression fractures as well as primary and metastatic neoplasms of the vertebral bodies at all levels.

Prior to the development of PVP, painful vertebral compression fractures (VCFs) were treated conservatively. Indeed, current recommendations for PVP include failure of conservative treatment as a procedural prerequisite. The initial treatment of patients with painful VCF is a combination of immobilization, external bracing, and analgesic drugs (2).

Many pharmacological therapies are aimed at preventing the bone demineralization that can lead to compression fracture. The commonly prescribed medications include bisphosphonates, alendronate, and risedronate, which bind to hydroxyapetite and inhibit resorption. These agents are usually well tolerated and available in once weekly preparations (3,4). Calcitonin, administered as a nasal spray, prevents osteoclast-mediated bone resorption and may have analgesic properties. Finally, teriparatide, a truncation product of human parathyroid hormone, stimulates bone formation and is available for subcutaneous injection. The use of these agents can decrease the incidence of VCFs by 60% in one year (5,6).

Surgical intervention is needed in a small percentage of patients with VCFs. This is usually secondary to a neurological deficit resulting from the fracture deformity.

Type
Chapter
Information
Pain Management in Interventional Radiology , pp. 43 - 57
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Galibert, P, Deramond, H, Rosat, P, Gars, D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33:166–8.Google ScholarPubMed
Tamayo-Orozco, J, Arzac-Palumbo, P, Peon-Vidales, H. Vertebral fractures associated with osteoporosis: patient management. Am J Med. 1997;18:S44–50.CrossRefGoogle Scholar
Simon, JA, Lewiecki, EM, Smith, ME, Petruschke, RA, Wang, L, Palmisano, JJ. Patient preference for once-weekly alendronate 70 mg versus once-daily alendronate 10 mg: a multicenter, randomized, open-label, crossover study. Clin Ther. 2002;24:871–86.CrossRefGoogle ScholarPubMed
Brown, JP, Kendler, DL, McClung, MR, et al. The efficacy and tolerability of risedronate once a week for the treatment of postmenopausal osteoporosis. Calcif Tissue Int. 2002;71:103–11.CrossRefGoogle ScholarPubMed
Harris, ST, Watts, NB, Genant, HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999;282:1344–52.CrossRefGoogle ScholarPubMed
Neer, RM, Arnaud, CD, Zanchetta, JR, et al. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344:1434–41.CrossRefGoogle ScholarPubMed
Fujita, T, Kostuik, JP, Huckell, CB, Sieber, AN. Complications of spinal fusion in adult patients more than 60 years of age. Orthop Clin North Am. 1998;29:669–78.CrossRefGoogle ScholarPubMed
Linville, DA, Bridwell, KH, Lenke, LG, Vedantam, R, Leicht, P. Complications in the adult spinal deformity patient having combined surgery. Does revision increase the risk?Spine. 1999;24:355–63.CrossRefGoogle ScholarPubMed
Hu, SS, Fontaine, F, Kelly, B, Bradford, DS. Nutritional depletion in staged spinal reconstructive surgery. The effect of total parenteral nutrition. Spine. 1998;23:1401–5.CrossRefGoogle ScholarPubMed
Hu, SS. Internal fixation in the osteoporotic spine. Spine. 1997;22(24 Suppl):43S–8S.CrossRefGoogle ScholarPubMed
Sarzier, JS, Evans, AJ, Cahill, DW. Increased pedicle screw pullout strength with vertebroplasty augmentation in osteoporotic spines. J Neurosurg. 2002;96(3 Suppl):309–12.Google ScholarPubMed
Wuisman, PI, Dijk, M, Staal, H, Royen, BJ. Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J. 2000;9:528–33.CrossRefGoogle Scholar
Lieberman, IH, Dudeney, S, Reinhardt, MK, Bell, G. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine. 2001;26:1631–8.CrossRefGoogle ScholarPubMed
Dublin, AB, Hartman, J, Latchaw, RE, Hald, JK, Reid, MH. The vertebral body fracture in osteoporosis: restoration of height using percutaneous vertebroplasty. Am J Neuroradiol. 2005;26:489–92.Google ScholarPubMed
Hiwatashi, A, Moritani, T, Numaguchi, Y, Westesson, P. Increase in vertebral body height after vertebroplasty. Am J Neuroradiol. 2003;23:185–9.Google Scholar
Riggs, BL, Melton, LJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17:505S–11S.CrossRefGoogle ScholarPubMed
Melton, LJ III. Epidemiology of spinal osteoporosis. Spine. 1997;22(Suppl 24):2S–11S.CrossRefGoogle ScholarPubMed
Jacobsen, SJ, Cooper, C, Gottlieb, MS, et al. Hospitalization with vertebral fracture among the aged: a national population based study, 1986–1989. Epidemiology. 1992;3(6):515–8.CrossRefGoogle ScholarPubMed
Kado, DM, Browner, WS, Palermo, L, Nevitt, MC, Genant, HK, Cummings, SR. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1999;159:1215–20.CrossRefGoogle ScholarPubMed
Cooper, C, Atkinson, EJ, Jacobsen, SJ, O'Fallon, WM, Melton, LJ III. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137:1001–5.CrossRefGoogle ScholarPubMed
World Health Organization Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report no. 843. Geneva; 1994.
Melton, LF III, Kan, SH, Frye, MA, Wahner, HW, O'Fallon, WM, Riggs, BL. Epidemiology of vertebral fractures in women. Am J Epidemiol. 1989;129:1000–11.CrossRefGoogle ScholarPubMed
Cooper, C, Atkinson, EJ, O'Fallon, WM, Melton, LJ III. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res. 1992;7:221–7.Google Scholar
Ross, RW, Small, EJ. Osteoporosis in men treated with androgen deprivation therapy for prostate cancer. J Urol. 2002;167:1952–6.CrossRefGoogle ScholarPubMed
Fitzpatrick, . Secondary causes of osteoporosis. Mayo Clin Proc. 2002;77:453–8.CrossRefGoogle Scholar
Nolla, JM, Gomez-Vaquero, C, Romera, M, et al. Osteoporotic vertebral fractures in clinical practice: 669 patients diagnosed over a 10 year period. J Rheumatol. 2001;28:2289–93.Google Scholar
Kobayashi, K, Shimoyama, K, Nakamura, K, Murata, K. Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol. 2005;15:360–7.CrossRefGoogle ScholarPubMed
McGraw, JK, Lippert, JA, Minkus, KD, Rami, PM, Davis, TM, Budzik, RF. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Intervent Radiol. 2002;13:883–6.CrossRefGoogle ScholarPubMed
Hodler, J, Peck, D, Gilula, . Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology. 2003;227:662–8.CrossRefGoogle ScholarPubMed
Grados, F, Depriester, C, Cayrolle, G, et al. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology. 2000;39:1410–4.CrossRefGoogle ScholarPubMed
Evans, AJ, Jensen, ME, Kip, KE, et al. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology. 2003;226:366–72.CrossRefGoogle ScholarPubMed
Trout, AF, Gray, , Kallmes, DF. Vertebroplasty in the inpatient population. Am J Neuroradiol. 2005;26:1629–33.Google ScholarPubMed
Chen, JF, Lee, ST. Percutaneous vertebroplasty for treatment of thoracolumbar spine bursting fracture. Surg Neurol. 2004;62:494–500.CrossRefGoogle ScholarPubMed
Schmorl, G, Junghanns, H. The Human Spine in Health and Disease. 2nd ed. New York: Grune and Stratton, 1971.Google Scholar
Laredo, JD, Reizine, D, Bard, M, Merland, JJ. Vertebral hemangiomas: radiographic evaluation. Radiology. 1986;161:183–9.CrossRefGoogle Scholar
Krueger, EG, Sobel, GL, Weinstein, C. Vertebral hemangioma with compression of the spinal cord. J Neurosurg. 1961;18:331–8.CrossRefGoogle Scholar
McAllister, VL, Kendall, BE, Bull, JW. Symptomatic vertebral haemangiomas. Brain. 1975;98:71–80.CrossRefGoogle ScholarPubMed
Nguyen, JP, Djindjian, M, Gaston, A, et al. Vertebral hemangiomas presenting with neurologic symptoms. Surg Neurol. 1987;27:391–7.CrossRefGoogle ScholarPubMed
Acosta, F, Dowd, C, Chin, C, Tihan, T, Ames, C, Weinstein, P. Treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas. Neurosurgery. 2006;58:287–95.CrossRefGoogle ScholarPubMed
Ide, C, Gangi, A, Rimmelin, A, et al. Vertebral haemangiomas with spinal cord compression: the place of preoperative percutaneous vertebroplasty with methyl methacrylate. Neuroradiology. 1996;38:585–9.CrossRefGoogle ScholarPubMed
Weill, A, Chiras, J, Simon, JM, et al. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology. 1996;199:241–7.CrossRefGoogle ScholarPubMed
Cotten, A, Dewatre, F, Cortet, B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology. 1996;200:525–30.CrossRefGoogle ScholarPubMed
Pilitsis, JG, Rengachary, SS. The role of vertebroplasty in metastatic spinal disease. Neurosurg Focus. 2001;11:1–4.CrossRefGoogle ScholarPubMed
Cortet, B, Cotten, A, Boutry, N, et al. Percutaneous vertebroplasty in patients with osteolytic metastases or multiple myeloma. Rhum Engl Rev Ed. 1997;64:177–83.Google ScholarPubMed
Brown, DB, Glaiberman, CB, Gilula, , Shimony, JS. Correlation between preprocedural MRI findings and clinical outcomes in the treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. Am J Roentg. 2005;184:1951–5.CrossRefGoogle ScholarPubMed
Maynard, AS, Jensen, ME, Schweickert, PA, Marx, WF, Short, JG, Kallmes, DF. Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures. Am J Neuroradiol. 2000;21:1807–12.Google ScholarPubMed
Jensen, ME, Dion, JE. Percutaneous vertebroplasty in the treatment of osteoporotic compression fractures. Neuroimaging Clin N Am. 2000;10:547–68.Google ScholarPubMed
Brown, DB, Gilula, , Seghal, M, Shimony, JS. Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. Am J Roentg. 2004;182:319–22.CrossRefGoogle ScholarPubMed
Kaufmann, TJ, Jensen, ME, Schweickert, PA, Marx, WF, Kallmes, DF. Age of fracture and clinical outcomes of percutaneous vertebroplasty. Am J Neuroradiol. 2001;22:1860–3.Google ScholarPubMed
Do, HM. Magnetic resonance imaging in the evaluation of patients for percutaneous vertebroplasty. Top Magn Reson Imaging. 2000;(4):235–44.CrossRefGoogle ScholarPubMed
Koyama, M, Takizawa, K, Kobayashi, K, et al. Initial experience of percutaneous vertebroplasty using single-plane C-arm fluoroscopy for guidance. Radiat Med. 2005;23(4):256–60.Google ScholarPubMed
Cotten, A, Dewatre, F, Cortet, B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology. 1996;200:525–30.CrossRefGoogle ScholarPubMed
Martin, JB, Gailloud, P, Dietrich, PY, et al. Direct transoral approach to C2 for percutaneous vertebroplasty. Cardiovasc Intervent Radiol. 2002;25:517–19.CrossRefGoogle ScholarPubMed
Gailloud, P, Martin, JB, Olivi, A, Rufenacht, DA, Murphy, KJ. Transoral vertebroplasty for a fractured C2 aneurysmal bone cyst. J Vasc Interv Radiol. 2002;13:340–1.CrossRefGoogle ScholarPubMed
Tong, FC, Cloft, HJ, Joseph, GJ, Rodts, GR, Dion, JE. Transoral approach to cervical vertebroplasty for multiple myeloma. Am J Roentgenol. 2000;175:1322–4.CrossRefGoogle ScholarPubMed
Mont'Alverne, F, Vallee, JN, Cormier, E, et al. Percutaneous vertebroplasty for metastatic involvement of the axis. Am J Neuroradiol. 2005;26(7):1641–5.Google ScholarPubMed
Kim, A, Jensen, M, Dion, J, Schweickert, P, Kaufmann, T, Kallmes, D. Unilateral transpedicular percutaneous vertebroplasty: initial experience. Radiology. 2002;222:737–41.CrossRefGoogle ScholarPubMed
Tanigawa, N, Komemushi, A, Kariya, S, Kojima, H, Sawada, S. Intraosseous venography with carbon dioxide contrast agent in percutaneous vertebroplasty. Am J Roentgenol. 2005;184:567–70.CrossRefGoogle ScholarPubMed
Jansen, ME, Evans, AJ, Mathis, JM, et al. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspect. Am J Neuroradiol. 1997;18:1897–904.Google Scholar
McGraw, JK, Heatwole, EV, Strnad, BT, Silber, JS, Patzilk, SB, Boorstein, JM. Predictive value of intraosseous venography before percutaneous vertebroplasty. J Vasc Interv Radiol. 2002;13:149–53.CrossRefGoogle ScholarPubMed
Weill, A, Chiras, J, Simon, JM, et al. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology. 1996;99:241–7.CrossRefGoogle Scholar
Gaughen, JR, Jensen, ME, Schweickert, PA, Kaufmann, TJ, Marx, WF, Kallmes, DF. Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures. Am J Neuroradiol. 2002;23:594–600.Google ScholarPubMed
Gaughen, JR Jr., Jensen, ME, Schweickert, PA, Kaufmann, TJ, Marx, WF, Kallmes, DF. Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutive procedures. Am J Neuroradiol. 2002;23:913–7.Google Scholar
Mathis, JM, Wong, W.Percutaneous vertebroplasty: technical considerations. J Vasc Interv Radiol. 2003;14:953–60.CrossRefGoogle ScholarPubMed
Belkoff, SM, Mathis, JM, Jasper, , Deramond, H. The biomechanics of vertebroplasty: the effect of cement volume on mechanical behavior. Spine. 2001;26:1537–41.CrossRefGoogle ScholarPubMed
Kaufmann, TJ, Wald, JT, Kallmes, DF. A technique to circumvent subcutaneous cement tracts during percutaneous vertebroplasty. Am J Neuroradiol. 2004;25:1595–6.Google ScholarPubMed
Dansie, DM, Luetmer, PH, Lane, JI, Thielen, KR, Wald, JT, Kallmes, DF. MRI findings after successful vertebroplasty. Am J Neuroradiol. 2005;26:1595–600.Google ScholarPubMed
Cotten, A, Dewatre, F, Cortet, B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology. 1996;200:525–30.CrossRefGoogle ScholarPubMed
Chiras, J.Percutaneous vertebral surgery: techniques and indications. J Neuroradiol. 1997;24:45–52.Google ScholarPubMed
Schmidt, R, Cakir, B, Mattes, T, Wegener, M, Puhl, W, Richter, M. Cement leakage during vertebroplasty: an underestimated problem?Eur Spine J. 2005;14:466–73.CrossRefGoogle Scholar
Seo, JS, Kim, YJ, Choi, BW, Kim, TH, Choe, KO. MDCT of pulmonary embolism after percutaneous vertebroplasty. AJR Am J Roentgenol. 2005;184:1364–5.CrossRefGoogle ScholarPubMed
Monticelli, F, Meyer, HJ, Tutsch-Bauer, E. Fatal pulmonary cement embolism following percutaneous vertebroplasty (PVP). Forensic Sci Int. 2005;149(1):35–8.CrossRefGoogle Scholar
Francois, K, Taeymans, Y, Poffyn, B, Nooten, G. Successful management of a large pulmonary cement embolus after percutaneous vertebroplasty: a case report. Spine. 2003;28(20):E424–5.CrossRefGoogle ScholarPubMed
Park, JH, Choo, SJ, Park, SW. Images in cardiovascular medicine: acute pericarditis caused by acrylic bone cement after percutaneous vertebroplasty. Circulation. 2005;111(6):e98.Google ScholarPubMed
Lindsay, R, Silverman, SL, Cooper, C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285:320–3.CrossRefGoogle ScholarPubMed
Uppin, AA, Hirsch, JA, Centenera, LV, Pfiefer, BA, Pazianos, AG, Choi, IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 2003;226(1):119–24.CrossRefGoogle ScholarPubMed
Syed, MI, Patel, NA, Jan, S, Harron, MS, Morar, K, Shaikh, A. New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. Am J Neuroradiol. 2005;26:1601–4.Google ScholarPubMed
Ananthakrishnan, D, Berven, S, Deviren, V, et al. The effect on anterior column loading due to different vertebral augmentation techniques. Clinical Biomechanics. 2005;20:25–31.CrossRefGoogle ScholarPubMed
Grados, F, Depriester, C, Cayrolle, G, et al. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology. 2000;39:1410–4.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×