medemb.htm

We report the pathological findings in cases of acrylic implants obtained by direct intratumoral injection of polymethyl-methacrylate (PMMA) and
N-butyl-cyano-acrylate (NBCA). Direct intratumoral injection of acrylic
implants was performed for a variety of primary and secondary bone lesions.
These types of treatments have been used at our institution in the last 4
years for 40 vertebroplasty (PMMA) procedures and for nine bone lesions of other locations (PMMA, NBCA). Postmortem histology became available for 1 case of PMMA and for 5 cases with NBCA intratumoral acrylic implants. The pathological findings associated with PMMA and NBCA were evaluated and compared.
PMMA exhibited a macroscopic and microscopic rim of tumor
necrosis, 6 months after implantation. NBCA exhibited compressive effects on the nearby tumor tissue, however, without signs of significant necrosis outside the acrylic tumor cast.
Tumor captured inside the acrylic cast showed extensive to near complete necrosis. Acrylic implants may lead to necrosis when injected directly in tumors. The necrotizing effect may extend beyond the limits of an implant in the case of PMMA. Such an extended effect of PMMA, when compared with NBCA, may be due to the variable toxicity of acrylic implants, including the different degrees of the exothermic reaction during polymerization.

Bone 1999 Aug;25(2 Suppl):23S-26S

An in vitro biomechanical evaluation of bone cements used in percutaneous vertebroplasty.

Belkoff SM, Maroney M, Fenton DC, Mathis JM

Department of Surgery, The University of Maryland, Baltimore, USA.
ebulson@surgery1.umaryland.edu

The purpose of this study was to determine the strength and stiffness of
osteoporotic vertebral bodies (VBs) subjected to compression fractures and
subsequently treated with bipedicular injections of various
polymethylmethacrylate cements. Ten spines were harvested from nonembalmed
female cadavers (age 68.6 +/- 13.7 years) and evaluated for bone mineral
density using the dual energy X-ray absorptiometry method (t-score = -2.3
+/- 2.4). The 50 VBs (L1-L5) were disarticulated, compressed in a materials
testing machine to determine initial strength and stiffness, and then
assigned to one of six groups. Two of these groups (n = 8, n = 9) concerned
experimental cements, the results of which are not reported here. The 33
vertebral bodies in the remaining four groups were left untreated or were
repaired using a transpedicular injection of one of three commercially
available polymethylmethacrylate cements. These four groups were: a) no
treatment (no cement, n = 8); b) Simplex P (n = 9); c) Cranioplastic (n =
8); and d) Osteobond (n = 8). The VBs were then compressed again according
to the initial protocol, and posttreatment strength and stiffness were
measured. Results suggested that bipedicular injection of Simplex P and
Osteobond restored VB stiffness to initial values, whereas VBs injected with
Cranioplastic were significantly less stiff than in their initial state. VBs
injected with cement (regardless of type) were significantly stronger than
they were initially.

Bone 1999 Aug;25(2 Suppl):17S-21S

Temperature elevation caused by bone cement polymerization during
vertebroplasty.

Deramond H, Wright NT, Belkoff SM

Department of Surgery, The University of Maryland, Baltimore, USA.

Percutaneous vertebroplasty (PVP), whereby polymethylmethacrylate cement is
injected into the vertebral body (VB), has been used to successfully treat
various spinal lesions. The mechanism responsible for the palliative effect
of PVP is unknown, but it may be the result of neural damage caused by heat
liberated during polymerization of the polymethylmethacrylate. The purpose
of the current study was to measure in vitro temperature histories at three
key locations (anterior cortex, center, spinal canal) in VBs injected with
one of two different bone cements (Simplex P and Orthocomp) to determine the
role temperature plays in PVP. Twelve VBs (T11-L2) from three elderly female
spines were instrumented with thermocouples and injected with 10 cc of one
of the two cements. Temperatures were measured with the VBs in a bath (37
degrees C) for 15 min after injection. A Student's paired t-test was used to
determine differences in peak temperature and time above 50 degrees C
between the two cement groups. Peak temperatures and temperatures above 50
degrees C were significantly higher and longer, respectively, at the center
of VBs injected with Simplex P (61.8 +/- 12.7 degrees C; 3.6 +/- 2.1 min)
than those injected with Orthocomp (51.2 +/- 6.2 degrees C; 1.3 +/- 1.4
min). There was no significant difference in peak temperature between
cements at the spinal canal location; temperature there did not rise above
41 degrees C. Although thermal damage to intraosseous neural tissue caused
by cement polymerization cannot be ruled out as a potential mechanism for
pain relief experienced by patients subsequent to PVP, it seems unlikely
based on the worst-case conditions tested in the current study.

Bone 1999 Aug;25(2 Suppl):11S-15S

Vertebroplasty: clinical experience and follow-up results.

Martin JB, Jean B, Sugiu K, San Millan Ruiz D, Piotin M, Murphy K, Rufenacht
B, Muster M, Rufenacht DA

Department of Neuroradiology, University Hospital HUG, University of Geneva,
Switzerland. jean.martin@medecine.unige.ch

This study was undertaken to report the clinical experience with
percutaneous minimal invasive vertebroplasty using polymethyl-methacrylcate
(PMMA) for a consecutive group of patients. Over the period of the last 4
years, 40 patients were treated at 68 vertebral segment levels with the
intention to relieve pain related to vertebral body lesions. Reduced
vertebral body height and destruction of the posterior vertebral wall were
not considered to be exclusion criterias. The vertebroplasty procedure was
performed under general anesthesia and in prone position with imaging
control using mostly biplane DSA fluoroscopic guidance, and rarely with
single-plane mobile DSA combined with computed tomographic guidance.
Unilateral, but more frequently bilateral, transpedicular introduction of a
2-3-mm OD needle was followed by an injection of polymethyl-methacrylcate
(PMMA). PMMA preparation involved a diluted mixture (20 mL powder for 5 mL
liquid) allowing for an extended polymerization time of up to 8 min. The
PMMA was mixed with metallic powder to enhance its radio-opacity. Before
PMMA injection, a vertebral phlebography was obtained to evaluate the
filling pattern and identify sites of potential PMMA leakage. Injection of
opacified PMMA was performed under continuous visual control with
fluoroscopy to obtain adequate filling and to avoid important PMMA leakage.
Clinical follow-up involved an evaluation using a questionnaire for
assessment of pain, pain medication, and mobility. One to six levels were
treated in one to three treatment sessions for patients with metastatic,
osteoporotic, and hemangiomatous lesions of the vertebral bodies who
presented with pain. The results observed matched those reported previously
with a success rate of approximately 80% and a complication rate below 6%
per treated level. Treatment failure and complications observed were related
to leakage, insufficient pretreatment evaluation, anesthesia, or patient
position during treatment. Image guidance with fluoroscopy was efficient
both for precise transpedicular approach and PMMA implantation control.
Vertebroplasty is very efficient for treatment of pain. Treatment failure
was mostly related to insufficient pretreatment clinical evaluation, and
complication due to excessive PMMA volume injection. Control of PMMA volume
seems to be the most critical point for avoiding complications. A good
fluoroscopy control is therefore mandatory.

AJNR Am J Neuroradiol 1999 Mar;20(3):375-7

Pulmonary embolism caused by acrylic cement: a rare complication of
percutaneous vertebroplasty.

Padovani B, Kasriel O, Brunner P, Peretti-Viton P

Department of Radiology, Hopital Pasteur, Nice, France.

A pulmonary embolus of acrylic cement was present in a 41-year-old woman
with Langerhans' cell vertebral histiocytosis (LCH) after percutaneous
vertebroplasty. Chest radiograph and CT confirmed pulmonary infarction and
the presence of cement in the pulmonary arteries. She was treated with
anticoagulants, and responded favorably. This rare complication occurred
because perivertebral venous migration was not recognized during
vertebroplasty. Adequate preparation of cement and biplane fluoroscopy are
recommended for vertebroplasty.

AJNR Am J Neuroradiol 1999 Feb;20(2):352-3

Exposure of medical personnel to methylmethacrylate vapor during
percutaneous vertebroplasty.

Cloft HJ, Easton DN, Jensen ME, Kallmes DF, Dion JE

Department of Radiology, University of Virginia Health Sciences Center,
Charlottesville 22908, USA.

The occupational exposure to methylmethacrylate (MMA) vapor during
percutaneous vertebroplasty was determined. During five vertebroplasty
procedures, air-sampling pumps were attached to medical personnel. MMA vapor
levels in the samples were then quantified using gas chromatography. The
samples collected yielded MMA vapor levels of less than five parts per
million (ppm). The MMA vapor concentrations measured were well below the
recommended maximum exposure of 100 ppm over the course of an 8-hour
workday.

J Neuroradiol 1998 Jul;25(2):123-8

[Percutaneous vertebroplasty of the cervico-thoracic junction using an
anterior route. Technique and results. Report of nine cases].

[Article in French]

Dufresne AC, Brunet E, Sola-Martinez MT, Rose M, Chiras J

Service de Neuroradiologie Charcot, Hopital de La Salpetriere, Paris,
France.

Percutaneous vertebroplasty using fluoroscopy is a well known technique.
Visualization of the posterior wall of the vertebra is mandatory. Good
assessment of this part of the vertebra is usually difficult at the
cervico-thoracic junction. We propose an original method to obtain adequate
visualization of the posterior wall, avoiding the shoulders superposition.
Using this technique, we performed twelve vertebroplasties in nine patients
(one angioma and eleven metastatic lesions). Clinical outcome was good for
all patients, even a total filling of the vertebra body by the cement was
obtained in only eight cases on twelve. No clinical complication was
observed.

Radiographics 1998 May-Jun;18(3):621-33

CT-guided interventional procedures for pain management in the lumbosacral
spine.

Gangi A, Dietemann JL, Mortazavi R, Pfleger D, Kauff C, Roy C

Department of Radiology B, University Hospital, Strasbourg, France.

The lumbosacral spine is the source of pain, suffering, and disability more
frequently than any other part of the body. Pain in the lower back can be
managed with computed tomography-guided analgesic interventional procedures,
such as periradicular infiltration, percutaneous laser disk decompression,
facet joint block, and percutaneous vertebroplasty. Periradicular injection
of steroids provides short-term and sometimes even long-term relief of low
back pain. Percutaneous laser disk decompression is used to treat
radiculalgia caused by disk herniation. Facet joint block is useful in
diagnosis and treatment of facet syndrome. Percutaneous vertebroplasty
provides short- and long-term pain relief in patients with vertebral body
disease. However, precise patient selection is essential to the success of
each of these techniques. The interventional radiologist has an active role
to play in minimally invasive management of lower back pain and should be
part of an interdisciplinary team that determines the appropriate therapy.

Radiol Clin North Am 1998 May;36(3):533-46

Percutaneous vertebroplasty with polymethylmethacrylate. Technique,
indications, and results.

Deramond H, Depriester C, Galibert P, Le Gars D

Service de Radiologie A, Centre Hospitalier Universitaire, Amiens, France.

Percutaneous vertebroplasty with acrylic cement consists of injecting
polymethylmethacrylate into vertebral bodies destabilized by osseous
lesions. The aim is to obtain an analgesic effect by reinforcing lesions of
the spine. The major indications are vertebral angiomas, osteoporotic
vertebral crush syndromes, and malignant spinal tumors. The clinically
significant complications occur predominantly in patients with spinal
metastatics, but in the great majority of cases they resolve with medical
treatment.

Radiographics 1998 Mar-Apr;18(2):311-20; discussion 320-3

Percutaneous vertebroplasty: state of the art.

Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet
P, Duquesnoy B, Deramond H

Department of Skeletal Radiology, Hopital Roger Salengro-CHRU de Lille,
France.

Vertebroplasty is an effective new radiologic procedure consisting of the
percutaneous injection of a biomaterial, usually methyl methacrylate, into a
lesion of a vertebral body. This technique allows marked or complete pain
relief and bone strengthening in most cases. The principal indications for
vertebroplasty are osteolytic metastasis and myeloma, painful or aggressive
hemangioma, and osteoporotic vertebral collapse with debilitating pain that
persists despite correct medical treatment. Radiography and computed
tomography must be performed in the days preceding vertebroplasty to assess
the extent of vertebral collapse, the location and extent of the lytic
process, the visibility and degree of involvement of the pedicles, the
presence of cortical destruction or fracture, and the presence of epidural
or foraminal stenosis caused by tumor extension or bone fragment
retropulsion. Leakage of methyl methacrylate during vertebroplasty may cause
compression of adjacent structures and necessitate emergency decompressive
surgery; thus, the procedure should be performed only in a surgical center.
The decision to perform vertebroplasty should be made by a multidisciplinary
team because the choice between vertebroplasty, surgery, radiation therapy,
medical treatment, or a combination thereof depends on a number of factors.
Radiologists need to be aware of the various indications for vertebroplasty
and of potential future developments and applications of the procedure.

Arthritis Rheum 1998 Jan;41(1):171-5

Percutaneous vertebroplasty treatment of steroid-induced osteoporotic
compression fractures.

Mathis JM, Petri M, Naff N

Johns Hopkins Hospital, Baltimore, Maryland, USA.

This report describes the case of a woman in whom multiple compression
fractures of the lower thoracic and lumbar spine occurred in association
with long-term corticosteroid therapy for systemic lupus erythematosus. Pain
markedly limited the patient's mobility and daily activities, and
conservative therapy with bracing and narcotic analgesics gave little
improvement. Affected vertebrae were treated with polymethylmethacrylate,
introduced percutaneously under fluoroscopic guidance. The resulting
reinforcement of the fractured vertebral bodies eliminated the pain and the
need for narcotic analgesics. The utilization of percutaneous
verterbroplasty as a therapeutic alternative for the treatment of pain
resulting from osteoporotic compression fractures is described.

AJNR Am J Neuroradiol 1997 Nov-Dec;18(10):1897-904

Percutaneous polymethylmethacrylate vertebroplasty in the treatment of
osteoporotic vertebral body compression fractures: technical aspects.

Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE

Department of Radiology, University of Virginia Health Sciences Center,
Charlottesville 22908, USA.

PURPOSE: To describe a technique for percutaneous vertebroplasty of
osteoporotic vertebral body compression fractures and to report early
results of its use. METHODS: The technique was used over a 3-year period in
29 patients with 47 painful vertebral fractures. The technique involves
percutaneous puncture of the involved vertebra(e) via a transpedicular
approach followed by injection of polymethylmethacrylate (PMMA) into the
vertebral body. RESULTS: The procedure was technically successful in all
patients, with an average injection amount of 7.1 mL PMMA per vertebral
body. Two patients sustained single, nondisplaced rib fractures during the
procedure; otherwise, no clinically significant complications were noted.
Twenty-six patients (90%) reported significant pain relief immediately after
treatment. CONCLUSION: Vertebroplasty is a valuable tool in the treatment of
painful osteoporotic vertebral fractures, providing acute pain relief and
early mobilization in appropriate patients.

J Neuroradiol 1997 Jun;24(1):45-59

[Percutaneous vertebral surgery. Technics and indications].

Chiras J, Depriester C, Weill A, Sola-Martinez MT, Deramond H

Service de Neuroradiologie Charcot, Hopital de La Salpetriere, Paris.

Percutaneous vertebroplasty is a technique of interventional radiology,
which allows to fulfill pathologic vertebral body with acrylic cement. This
method is used to strengthen the vertebral body and reduce pain in some
diseases involving the vertebra. Main indications are spine angiomas,
metastases and osteoporosis. The vertebroplasty is realised under
neuroleptanalgesia for cervical spine antero lateral way is used. For
thoracic or lumbar vertebra, the way of approach is usually transpedicular;
but in some cases, this approach is not possible: osteolysis of the pedicle,
surgical osteosynthesis; in such cases, a postero lateral approach is
realized. Technical incidents are not rare, but are usually asymptomatic.
More frequent are venous filling with cement; the veins involved can be
intra spinal (vertebral plexus) or paraspinal. Instead of this frequency
pulmonary embolism in direct relation with the vertebroplasty where not
reported. Extravasation in intervertebral disk or soft tissue can also be
observed. This last incident can be in relation with the way of the needle
or with a cortical rupture. Local complications are rare: rate of
neurological deficit or infection is under 0.5%. Radicular pain is observed
in 3.7% of cases. These complications are in close relation with the
radiological involvement of the vertebra: cortical disruption, heterogeneous
Lysis of the vertebral body. The frequency of complications is 1.3% in
osteoporosis, 2.5% in spine angiomas and 10% in metastatic disease.
Indications concern lesion involving the vertebral body: Symptomatic spine
angiomas; painful osteoporotic fractures after medical treatment or in
patients with a high risk of decubitus complications; in metastatic disease,
vertebroplasty is a way to consolidate the vertebral body and release pain.
It can be usefull in recurrent pain after chemotherapy and/or radiotherapy,
and also in unstable vertebra to obtain a stabilization before radiotherapic
or chemotherapic treatment isolated or in combination with surgical
osteosynthesis.

Cancer Radiother 1997;1(3):234-9

[Radiotherapy of spinal metastases in breast cancer. Apropos of a series of
108 patients].

[Article in French]

Prie L, Lagarde P, Palussiere J, el Ayoubi S, Dilhuydy JM, Durand M, Vital
JM, Kantor G

Institut Bergonie, centre regional de lutte contre le cancer, Bordeaux,
France.

PURPOSE: Retrospective analysis of analgesic, decompressive and
remineralization effects of radiation therapy for spinal metastases in
breast cancer. PATIENTS AND METHODS: From January 1990 to December 1992, 108 patients with breast cancer were treated by irradiation at the Bergonie
Institute for a first spinal metastasis. Three patients had undergone
previous surgery (laminectomy and Doves' frame). The indication of radiation
therapy was analgesic (102 patients) or decompressive (six patients). The
usual irradiation scheme was 30 Gy/10 fractions/2 weeks. RESULTS: The
analgesic effect was considered as 'complete' or 'almost complete' (83%),
'moderate' (13%) or absent (4%). The mean time to the maximum analgesic
response was 35 days. The duration of both the analgesic response and
remineralization effects could not be retrospectively assessed due to lack
of data. Decompressive effects were complete in five cases and absent in one
case. A second spinal radiation therapy was necessary 78 times (eight times
in junction field within 6 months following the first treatment). Spinal
cord compression occurred either out of (three cases) or within (one case)
the irradiated field. CONCLUSION: Radiation therapy for spinal metastases in
breast cancer remains a palliative analgesic treatment. Indication for
decompression is rare. However, assessment of compressive 'risk' leads to
discussion of radiological staging (contribution of magnetic resonance
imaging) and possible previous treatment (vertebroplasty or osteosynthesis).

Rev Rhum Engl Ed 1997 Mar;64(3):177-83

Percutaneous vertebroplasty in patients with osteolytic metastases or
multiple myeloma.

Cortet B, Cotten A, Boutry N, Dewatre F, Flipo RM, Duquesnoy B, Chastanet P,
Delcambre B

Rheumatology Department, Roger Salengro Teaching Hospital, Lille, France.

Osteolytic metastases and spinal myeloma lesions are difficult to treat
because they denote disseminated malignant disease. The pain-relieving and
other effects of radiation therapy are delayed. We evaluated short- and
medium-term outcomes of vertebroplasty in this indication, in patients with
severe or excruciatingly severe pain (McGill-Melsack score 4 or 5)
unresponsive to narcotics. PATIENTS AND METHODS: forty vertebras were
treated in 37 patients including 29 with bone metastases and eight with
multiple myeloma. Mean age was 58 years (range 36-83). The spinal segment
involved was the cervical spine in five cases, the thoracic spine in 12 and
the lumbar spine in 23. Vertebroplasty was done under fluoroscopy guidance
after premedication and local anesthesia. RESULTS: thirty-six patients
(97.3%) reported a decrease in their pain 48 hours after the procedure; five
of these patients (13.5%) were completely free of pain, 20 (55%) were
significantly improved and 11 (30%) were moderately improved. One patient
failed to respond. The clinical results were not correlated to the extent of
vertebral body filling. Beneficial effects were increased or unchanged in
100% of cases after one month, 88.9% after three months and 75% after six
months. Leakage of the cement outside the vertebral body occurred in 29
cases (72.5%), usually into the paraspinal soft tissues (n = 21,52.5%).
Leakage was usually clinically silent and only two patients developed severe
nerve root pain due to leakage into a neural foramen, with in both instances
a favorable outcome after surgery. CONCLUSION: Vertebroplasty is simple
and effective for the treatment of osteolytic metastases and multiple
myeloma lesions, but should be performed only in centers with neurosurgical
and/or orthopedic surgery units because of the possibility of severe complications.

Neuroradiology 1996 Aug;38(6):585-9

Vertebral haemangiomas with spinal cord compression: the place of
preoperative percutaneous vertebroplasty with methyl methacrylate.

Ide C, Gangi A, Rimmelin A, Beaujeux R, Maitrot D, Buchheit F, Sellal F,
Dietemann JL

Department of Radiology 2, University Hospital of Strasbourg, Hopital de
Hautepierre, France.

We report on cervical and two thoracic vertebral haemangiomas with
neurological disturbance successfully treated by percutaneous vertebroplasty
followed by decompression surgery. Vertebroplasty consolidates the vertebral
body and reduces the risk of haemorrhage. Subsequent surgery may be limited
to decompressive laminectomy and resection of the epidural extension of the
haemangioma. embolisation was also carried out in one case. Complete
neuroimaging workup, including CT, myelo-CT and MRI, is necessary prior to
treatment.

Radiology 1996 Aug;200(2):525-30

Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects
of the percentage of lesion filling and the leakage of methyl methacrylate
at clinical follow-up.

Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, Chastanet
P, Clarisse J

Department of Skeletal Radiology, Hopital B-CHRU de Lille, France.

PURPOSE: To determine whether the percentage of vertebral lesion filling and
the leakage of methyl methacrylate have any clinical significance at
follow-up. MATERIALS AND METHODS: Forty percutaneous vertebroplasties were
performed for metastases (30 cases) and myeloma (10 cases) in 37 patients. A
computed tomographic scan was obtained 1-8 hours after methyl methacrylate
injection and was used to assess the percentage of lesion filling by methyl
methacrylate and the leakage of methyl methacrylate into the epidural
tissues, neural foramina, intervertebral disks, venous plexus, and
paravertebral tissue. The results were correlated with those obtained at
clinical follow-up. RESULTS: Partial or complete pain relief was sustained
in 36 of 37 patients. Pain relief was not proportional to the percentage of
lesion filling. Clinical improvement was maintained in most patients. The 15
epidural leaks, eight intradiskal leaks, and two venous leaks of methyl
methacrylate had no clinical importance. Two of eight foraminal leaks
produced nerve root compression that required decompressive surgery. One of
21 paravertebral leaks produced transitory femoral neuropathy. CONCLUSION:
Pain relief can occur despite insufficient lesion filling. In most patients,
intradiskal and paravertebral leaks of cement had no clinical importance.

Neuroradiology 1996 May;38(4):392-4

Asymptomatic cervical haemangioma treated by percutaneous vertebroplasty.

Dousset V, Mousselard H, de Monck d'User L, Bouvet R, Bernard P, Vital JM,
Senegas J, Caille JM

Department of Neuroradiology, Hopital Pellegrin Tripode, Bordeaux, France.

We report a 17-year-old asymptomatic patient with a partially collapsed
seventh cervical vertebra due to a haemangioma revealed by conventional
radiographs performed for army enrollment. Given radiological evidence of
aggressiveness, percutaneous vertebroplasty by injection of methyl
methacrylate cement was performed to prevent complications. CT a year later
showed no progression of the lesion. The patient remains asymptomatic.

Neuroradiology 1996 May;38(4):389-91

Acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas:
report of 2 cases.

Feydy A, Cognard C, Miaux Y, Sola Martinez MT, Weill A, Rose M, Chiras J

Service de Neuroradiologie Charcot, Hopital Pitie-Salpetriere, Paris,
France.

We report two cases of acrylic vertebroplasty in symptomatic cervical
vertebral haemangiomas. In both cases significant improvement of symptoms
was rapid. One patient was able to return to work.

Radiology 1996 Apr;199(1):241-7

Spinal metastases: indications for and results of percutaneous injection of
acrylic surgical cement.

Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E

Department of Neuroradiology, Groupe Hospitalier Pitie-Salpetriere, Paris,
France.

PURPOSE: To determine the efficacy of percutaneous vertebroplasty in
treating spinal metastases that result in pain or instability. MATERIALS AND
METHODS: Thirty-seven patients (20 men, 17 women; aged 33-86 years)
underwent 52 percutaneous injections of surgical cement into a vertebra
(vertebroplasty) with fluoroscopic guidance in 40 procedures. Vertebroplasty
was performed for analgesia in 29 procedures, stabilization of the vertebral
column in five procedures, and both in six procedures. RESULTS: Twenty-four
of the 33 procedures performed for analgesia that were evaluated resulted in
clear improvement; seven, moderate improvement; and two, no improvement.
Improvement was stable in 73% of patients at 6 months. In the procedure
performed for stabilization, no displacement of treated vertebrae was
observed (mean follow-up, 13 months). Three patients had transient
radiculopathy due to cement extrusion, and two patients had transient
difficulty in swallowing. CONCLUSION: Vertebroplasty of metastases is a
minimally invasive procedure that provides immediate and long-term pain
relief and contributes to spinal stabilization.

Bone 1996 Mar;18(3 Suppl):191S-196S

General management of vertebral fractures.

Rapado A

Servicio de Medicina Interna, Fundacion Jimenez Diaz, Madrid, Spain.

Vertebral fractures cause pain and disability. Four concepts should guide
their comprehensive management: treat the patient, not the skeleton; use a
multidisciplinary approach; engage the patient and his or her family in the
treatment; and provide appropriate goals, education, encouragement, and
support. The goals include procuring bone mass and preventing injury: back
support, physical therapy, occupational therapy, psychosocial support, and
prevention of falls. Initial treatment includes bed rest, pain management
with local and systemic analgesia, bracing to improve comfort, and patient
reassurance. Long-term management includes spinal stretching exercises and
continuing ordinary activities within limits permitted by pain. A back
school program is an effective addition to conventional concepts using
physiotherapy exclusively. In certain selected patients, the indication for
operative treatment of vertebral fracture depends on the additional injury,
and extent and characteristics of cord compression; stability of the
fracture; and the amount of deformity. Vertebroplasty can be effective in
the control of pain and in obtaining stability of the spine.

Bull Cancer Radiother 1996;83(4):277-82

[Vertebroplasty and percutaneous interventional radiology in bone
metastases: techniques, indications, contra-indications].

[Article in French]

Deramond H, Depriester C, Toussaint P

Service de radiologie A, CHU Amiens, France.

Rev Med Interne 1995;16(11):854-9

Vertébroplasties percutanées

[Article in French]

Chiras J, Sola-Martinez MT, Weill A, Rose M, Cognard C, Martin-Duverneuil N

Service de neuroradiologie Charcot, hopital de la Pitie-Salpetriere, Paris,
France.

Vertebroplasty is a new therapeutic method which by way of filling with
acrylic cement in the vertebral body gives a stabilization of the vertebra
and an antalgic effect in painful lesions involving the spine. Main
indications consist of spine angiomas, metastases and osteoporotic fractures
involving the vertebral body. In most patients, vertebroplasty gives a very
good and durable antalgic effect as in cases of angiomas or metastases as in
post-therapeutic sequellae in malignant hematosarcomas. In osteoporotic
fractures, antalgic effect is obtained very rapidly, but the follow-up is
actually insufficient to evaluate the long term benefit.