What's new in vertebral cementoplasty?

Abstract

Vertebral cementoplasty is a well-known mini-invasive treatment to obtain pain relief in patients affected by vertebral porotic fractures, primary or secondary spine lesions and spine trauma through intrametameric cement injection. Two major categories of treatment are included within the term vertebral cementoplasty: the first is vertebroplasty in which a simple cement injection in the vertebral body is performed; the second is assisted technique in which a device is positioned inside the metamer before the cement injection to restore vertebral height and allow a better cement distribution, reducing the kyphotic deformity of the spine, trying to obtain an almost normal spine biomechanics. We will describe the most advanced techniques and indications of vertebral cementoplasty, having recently expanded the field of applications to not only patients with porotic fractures but also spine tumours and trauma.

Figure 1.

(a, b) A 71-year-old male affected by osteoporotic fracture of the L1; latero-lateral (a) and anteroposterior (b) fluoroscopy controls after vertebroplasty (VP) of the L1 associated with prophylactic VP of the T12 and L2.

Figure 2.

(a–e) A 65-year-old male affected by multiple myeloma suffering from back pain, resistant to medical therapy. Multiple vertebral compression fractures on sagittal T₁ weighted and T₂ weighted MRI (a–b), some of them with sclerotic responses as shown on sagittal multiplanar-reformatted multidetector CT (c). Latero-lateral and anteroposterior fluoroscopy controls after vertebroplasty performed at the thoracolumbar junction.

Figure 3.

(a–i) A 68-year-old female affected by multiple myeloma suffering from back pain, resistant to medical therapy. A vertebral compression fracture at the T11 with soft epidural tissue infiltration on sagittal T₂ weighted, short tau inversion recovery and T₁ weighted MRI (a–c). Latero-lateral (LL) and anteroposterior (AP) fluoroscopy controls during vertebroplasty (VP) of the T11 (d–e) by bipeduncolar approach. LL fluoroscopy control after radiofrequency (RF) ablation needle placement into the T11 (f). AP and LL fluoroscopy controls after VP using an RF ablation system (g–h). Post-VP multiplanar-reformatted multidetector CT control showed good distribution of the cement into the vertebral body without leakages (i).

Figure 4.

(a–c) A 65-year-old female affected by breast cancer with lytic metastasis involving the left pedicle and posterior arch of the T8 (a). Latero-lateral and anteroposterior fluoroscopy controls after vertebroplasty performed using radiofrequency system injection show a paravertebral venous leakage (b–c).

Figure 5.

(a–d) A large non-Hodgkin lymphoma destroying the right hemivertebra of the L5 and right sacral wing (a–b). Thanks to a CT-guided sacroplasty, poly-methyl-methacrylate injection completely refilled the osteolytic areas, avoiding intraforaminal leakages at the sacrum level.

Figure 6.

(a–r) A 30-year-old male affected by symptomatic aneurysmal bone cyst resistant to medical therapy involving the body and posterior elements of the L3 (a–d). Under fluoroscopy control, with the patient standing prone and under neuroleptoanalgesia, a bioactive cement (Cerament™; Bonesupport®, Sweden) was injected into the L3 by a monopeduncolar approach filling the lesion without cement leakages (e–h). The post-treatment multidetector CT (MDCT) with multiplanar-reformatted (MPR) and three-dimensional volume rendering reconstructions confirmed the cement distribution into the lesion without cement leakages (i–n). The 6-month MDCT with MPR reconstruction follow-up showed the sclerotic bone remodelling of the aneurysmal cyst with periosteal new bone formation, followed by recalcification within the cystic cavity (o–r).

Figure 7.

(a–f) A 35-year-old male affected by a traumatic A1 Margerl vertebral compression fracture of the T11. Under fluoroscopy control, with the patient standing prone and under neuroleptoanalgesia, a bioactive cement (Cerament™; Bonesupport®, Sweden) was injected into the T11 by bipeduncolar approach without cement leakages (a–c). The 4-month multidetector CT follow-up with multiplanar-reformatted reconstructions showed the sclerotic bone reaction of the fracture (d–f).

Figure 8.

(a–g) A 42-year-old female affected by a traumatic vertebral compression fracture of the T12 with kyphosis deformity on sagittal multiplanar-reformatted multidetector CT reconstruction (a). Under fluoroscopy control, with the patient standing prone and under neuroleptoanalgesia, the SpineJack® device (Vexim®, France) was placed into the T12 by a bipeduncolar approach (c–e) without cement leakages. The anteroposterior and latero-lateral fluoroscopy controls after cement injection show no leakages (f–g).