Vertebroplasty: Clinical experience and follow-up results

This study was undertaken to report the clinical experience with percutaneo us minimal invasive vertebroplasty using polymethyl-methacrylate (PMMA) for a consecutive group of patients, Over the period of the last 4 years, 40 p atients were treated at 68 vertebral segment levels with the intention to r elieve pain related to vertebral body lesions. Reduced vertebral body heigh t and destruction of the posterior vertebral wall were not considered to be exclusion criterias, The vertebroplasty procedure was performed under gene ral anesthesia and in prone position with imaging control using mostly bipl ane DSA fluoroscopic guidance, and rarely with single-plane mobile DSA comb ined with computed tomographic guidance. Unilateral, but more frequently bi lateral, 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 mi, 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 phlebogra phy was obtained to evaluate the filling pattern and identify sites of pote ntial PMMA leakage. Injection of opacified PMMA was performed under continu ous 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 wi th metastatic, osteoporotic, and hemangiomatous lesions of the vertebral bo dies who presented with pain. The results observed matched those reported p reviously with a success rate of approximately 80% and a complication rate below 6% per treated level. Treatment failure and complications observed we re related to leakage, insufficient pretreatment evaluation, anesthesia, or patient position during treatment. Image guidance with fluoroscopy was eff icient both for precise transpedicular approach and PMMA implantation contr ol. Vertebroplasty is very efficient for treatment of pain, Treatment failu re was mostly related to insufficient pretreatment clinical evaluation, and complication due to excessive PMMA volume injection, Control of PMMA volum e seems to be the most critical point for avoiding complications. A good fl uoroscopy control is therefore mandatory. (Bone 25:11S-15S; 1999) (C) 1999 by Elsevier Science Inc. All rights reserved.