II. Indications: Pain refractory to conservative management
- Vertebral Compression Fracture >2 weeks old
- Vertebral involvement of Multiple Myeloma
- Metastases to Vertebrae
- Vertebral Hemangiomas
- Vertebral osteonecrosis
III. Contraindications
- Absolute contraindication
- Untreated Coagulopathy
- Vertebral Osteomyelitis
- Relative contraindication
IV. Technique
- Usually performed by Interventional Radiology
- Patient under moderate Conscious Sedation
- Positioned prone for the procedure
- Needle (11 gauge) advanced under fluoroscopy
- Needle passed via each of the two pedicles
- Acrylic cement injected into affected Vertebral body
- Polymethylmethacrylate (PMMA)
- Radiopaque material used also (e.g. barium)
- Total volume injected: Up to 12 cm3
- Patient supine one hour for cement to harden
- Patient observed for two hours after procedure
- Pain relief may be delayed up to 72 hours
V. Modifications: Kyphoplasty (studies in progress)
VI. Complications (1-3% in Osteoporosis, 7-10% in neoplasm)
- Initial pain exacerbation
- Fever
- Bleeding
- Rib or pedicle Fracture
- Extruded cement with resulting nerve compression
- Cement Pulmonary Embolism