Percutaneous Vertebroplasty

Aka: Percutaneous Vertebroplasty, Percutaneous Kyphoplasty, Vertebroplasty, Kyphoplasty

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II. Indications: Pain refractory to conservative management

  1. Vertebral Compression Fracture >2 weeks old
  2. Vertebral involvement of Multiple Myeloma
  3. Metastases to Vertebrae
  4. Vertebral Hemangiomas
  5. Vertebral osteonecrosis

III. Contraindications

  1. Absolute contraindication
    1. Untreated Coagulopathy
    2. Vertebral Osteomyelitis
  2. Relative contraindication
    1. Mass significantly impinges on spinal canal
    2. Vertebral body collapse >80%
    3. Vertebral Fracture present >1 year

IV. Technique

  1. Usually performed by Interventional Radiology
  2. Patient under moderate Conscious Sedation
  3. Positioned prone for the procedure
  4. Needle (11 gauge) advanced under fluoroscopy
  5. Needle passed via each of the two pedicles
  6. Acrylic cement injected into affected Vertebral body
    1. Polymethylmethacrylate (PMMA)
    2. Radiopaque material used also (e.g. barium)
    3. Total volume injected: Up to 12 cm3
  7. Patient supine one hour for cement to harden
  8. Patient observed for two hours after procedure
  9. Pain relief may be delayed up to 72 hours

V. Modifications: Kyphoplasty (studies in progress)

  1. Vertebra is expanded with high pressure balloon
  2. Cement injected and Restores height to Vertebra

VI. Complications (1-3% in Osteoporosis, 7-10% in neoplasm)

  1. Initial pain exacerbation
  2. Fever
  3. Bleeding
  4. Rib or pedicle Fracture
  5. Extruded cement with resulting nerve compression
  6. Cement Pulmonary Embolism

VII. Efficacy

  1. Good pain relief in up to 90% Vertebral Fractures

VIII. References

  1. Deramond (1998) Radiol Clin North Am 36:533-46 [PubMed]
  2. Predey (2002) Am Fam Physician 66(4):611-17 [PubMed]

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Ontology: Vertebroplasty (C1303192)

Definition (MSH) Procedures to repair or stabilize vertebral fractures, especially compression fractures accomplished by injecting BONE CEMENTS into the fractured VERTEBRAE.
Definition (NCI) A nonsurgical method for the repair of vertebral fractures and compression due to osteoporosis in which a glue-like material is inserted into the center of the collapsed spinal vertebra in order to stabilize and strengthen the crushed bone.
Definition (NCI_NCI-GLOSS) A procedure used to repair a bone in the spine that has a break caused by cancer, osteoporosis (a decrease in bone mass and density), or trauma. Bone cement is injected into the broken bone to make it stronger.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D054854
SnomedCT 401226007
CPT 1013895
English vertebroplasty, Vertebroplasty, vertebroplasty procedure, Vertebroplasty Procedures, Vertebroplasty (procedure)
Portuguese Vertebroplastia
Finnish Vertebroplastia
French Vertébroplastie, VTP (VertébroPlastie), Spondyloplastie
German Vertebroplastie, Wirbelsaeulenplastik
Italian Vertebroplastica
Russian ВЕРТЕБРОПЛАСТИКА, VERTEBROPLASTIKA
Japanese ﾂｲﾀｲｹｲｾｲｼﾞｭﾂ, 椎体形成術, バルーン椎体形成術, 椎体形成術-バルーン, 後弯形成術
Czech Vertebroplastika, vertebroplastika
Spanish Vertebroplastia, vertebroplastia (procedimiento), vertebroplastia
Swedish Vertebroplastik
Polish Plastyka kręgów, Wertebroplastyka balonowa, Wertebroplastyka
Hungarian Vertebroplastica
Norwegian Not Translated[Vertebroplasty]
Dutch vertebroplastiek
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Kyphoplasty (C1455863)

Definition (NCI) A procedure with the intent of expanding a collapsed vertebra. A surgical instrument is introduced into the spine with a balloon that is inflated to expand the bone. Once this instrument is withdrawn, the space created is then filled with bone cement mixture.
Definition (MSH) Procedures to restore vertebrae to their original shape following vertebral compression fractures by inflating a balloon inserted into the vertebrae, followed by removal of the balloon and injection of BONE CEMENTS to fill the cavity.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D058498
Dutch kyfoplastiek
German Kyphoplastik, Kyphoplastie, Ballon-Kyphoplastie
Italian Chifoplastica, Cifoplastica, Vertebroplastica con palloncino
Portuguese Quifoplastia, Cifoplastia
English kyphoplasty, Kyphoplasty, Balloon Vertebroplasty, Vertebroplasty, Balloon
Japanese 椎骨形成術, ﾂｲｺﾂｹｲｾｲｼﾞｭﾂ
Czech Kyfoplastika, kyfoplastika
French Spondyloplastie par ballonnet, Cyphoplastie par ballonnet, Vertébroplastie par ballonnet, Kyphoplastie, Spondyloplastie avec expansion, Cyphoplastie
Spanish Cifoplastia
Russian ВЕРТЕБРОПЛАСТИКА БАЛЛОННАЯ, KIFOPLASTIKA, КИФОПЛАСТИКА, VERTEBROPLASTIKA BALLONNAIA
Hungarian Kyphoplastica
Polish Kifoplastyka
Norwegian Ballongvertebroplastikk, Kyfoplastikk
Derived from the NIH UMLS (Unified Medical Language System)

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