Surgically controlled, transpedicular methyl methacrylate vertebroplasty with fluoroscopic guidance

The authors report a series of 13 patients with osteoporotic vertebral frac tures treated by transpedicular vertebroplasty. Because of a neurological c omplication due to posterior leakage of acrylic cement the classical percut aneous approach was converted to an open surgical procedure. The latter all ows direct visual control of neural structures and immediate removal of spi lled cement, thus eliminating the danger of compressive, chemical and therm al effects of methyl methacrylate on neural elements. By use of this elegant technique primary stability of fractured vertebras i s obtained leading to prompt pain relief in all patients. Surgically contro lled vertebroplasty can be used in conjunction with internal fixation. By h aving studied the different ways of cement escape in their patients, the au thors are convinced that surgically controlled vertebroplasty is safer than percutaneous vertebroplasty.