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Percutaneous Vertebroplasty
Aka: Percutaneous Vertebroplasty, Percutaneous Kyphoplasty, Vertebroplasty, Kyphoplasty
- Indications: Pain refractory to conservative management
- Vertebral Compression Fracture >2 weeks old
- Vertebral involvement of Multiple Myeloma
- Metastases to Vertebrae
- Vertebral Hemangiomas
- Vertebral osteonecrosis
- Contraindications
- Absolute contraindication
- Untreated Coagulopathy
- Vertebral Osteomyelitis
- Relative contraindication
- Mass significantly impinges on spinal canal
- Vertebral body collapse >80%
- Vertebral Fracture present >1 year
- 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
- Modifications: Kyphoplasty (studies in progress)
- Vertebra is expanded with high pressure balloon
- Cement injected and Restores height to Vertebra
- 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
- Efficacy
- Good pain relief in up to 90% Vertebral Fractures
- References
- Deramond (1998) Radiol Clin North Am 36:533-46 [PubMed]
- Predey (2002) Am Fam Physician 66(4):611-17 [PubMed]