Percutaneous Vertebroplasty

Aka: Percutaneous Vertebroplasty, Percutaneous Kyphoplasty, Vertebroplasty, Kyphoplasty

1. 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
2. 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
3. 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
4. Modifications: Kyphoplasty (studies in progress)
   1. Vertebra is expanded with high pressure balloon
   2. Cement injected and Restores height to Vertebra
5. 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
6. Efficacy
   1. Good pain relief in up to 90% Vertebral Fractures
7. References
   1. Deramond (1998) Radiol Clin North Am 36:533-46 [PubMed]
   2. Predey (2002) Am Fam Physician 66(4):611-17 [PubMed]