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Review
. 2007 Jul;53(7):1169-75.

Back stab: percutaneous vertebroplasty for severe back pain

Susitna Banerjee  1 , Mark Otto Baerlocher, Murray R Asch
Affiliations
Review

Back stab: percutaneous vertebroplasty for severe back pain

Susitna Banerjee et al. Can Fam Physician. 2007 Jul.

Abstract
in English, French

Objective: To review the evidence supporting use of percutaneous vertebroplasty for relief of pain and mechanical stability in patients with vertebral compression fractures unrelieved by conventional measures.

Quality of evidence: Ovid MEDLINE was searched from January 1966 to December2006 for all English-language papers on vertebroplasty. The quality of evidence in these papers was graded according to the 4-point classification system of evidence-based medicine. Level II evidence currently supports use of vertebroplasty.

Main message: Vertebroplasty alleviates pain from vertebral compression fractures that result from osteoporosis, hemangiomas, malignancies, and vertebral osteonecrosis. Vertebroplasty has provided substantial pain relief in 60% to 100% of patients; has decreasedanalgesic use in 34% to 91% of patients; and has improved physical mobility in 29% to 100% of patients. Contraindications to vertebroplasty include asymptomatic compression fractures of the vertebral body, vertebra plana, retropulsed bone fragments or tumours, active infection, uncorrectable coagulopathy, allergy to the bone cement or opacification agent, severe cardiopulmonary disease, pregnancy, and pre-existing radiculopathy. The short-term complication rate was found to be 0.5% to 54%. Rare but serious complications include compression of the spinal cord or nerve root, infection, cement embolization causing pulmonary infarct and clinical symptoms, paradoxical embolization of the cerebral artery, and severe hematomas.

Conclusion: Vertebroplasty is a safe and effective treatment for vertebral fractures that cannot be treated using conservative measures.

OBJECTIF: Faire le point sur les données qui supportent l’utilisation de la vertébroplastie percutanée pour soulager la douleur et assurer une stabilité mécanique dans les cas de tassements vertébraux rebelles au traitement conventionnel.

QUALITÉ DES PREUVES: On a repéré dans Ovid MEDLINE entre janvier 1966 et décembre 2006 tous les articles de langue anglaise sur la vertébroplastie. La qualité des preuves contenues dans ces articles a été évaluée selon le système de classification en 4 points pour la médecine basée sur des données probantes. L’utilisation de la vertébroplastie est présentement supportée par des preuves de niveau II.

PRINCIPAL MESSAGE: La vertébroplastie soulage la douleur des tassements vertébraux résultant d’ostéoporose, d’hémangiomes, de néoplasies et d’ostéonécrose vertébrale. Cette intervention a produit une importante réduction de la douleur chez 60 à 100% des patients; a entraîné une baisse de l’utilisation des analgésiques chez 34 à 91% des sujets; et a amélioré la mobilité des patients dans 29 à 100% des cas. Un taux de complications à court terme de 0,5 à 54% a été observé. Les complications graves sont rares; elles incluent: compression de la moelle épinière ou de racine nerveuse, infection, embolie de ciment avec infarctus pulmonaire cliniquement symptomatique, embolie paradoxale d’une artère cérébrale ethématome sévère.

CONCLUSION: La vertébroplastie est une méthode sûre et efficace pour traiter les fractures vertébrales rebelles au traitement conventionnel.

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References

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