Vertebroplasty: clinical experience and follow-up results

Abstract

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.