Vertebroplasty in Osteoporotic Vertebral Fractures: Technical Considerations and Complications
Dhurvas R Ramprasath, Vasudevan Thirunarayanan, Joseph David Vimal Kumar, Arjun Rajan, Kabilan Muthulingam
Citation Information :
Ramprasath DR, Thirunarayanan V, Kumar JD, Rajan A, Muthulingam K. Vertebroplasty in Osteoporotic Vertebral Fractures: Technical Considerations and Complications. 2020; 2 (1):17-21.
Background: Osteoporosis is a global problem involving majority of elderly population. Vertebral compression fracture in this population leads to severe pain and decreased quality of life. Percutaneous vertebroplasty alleviates the pain, with a minimal invasive approach. The aim of our study was to analyze the technical considerations and complications of this surgery.
Materials and methods: Vertebroplasty was performed in 35 patients with male: female ratio 13:22 in the age group of 52–80 years. We used unipedicular needle insertion and injected 2–3 mL of high-viscosity polymethylmethacrylate in the fractured vertebral body. Visual analog score, Oswestry disability score, and Oswestry disability index were used to analyze functional outcome.
Results: Pain relief had a significant p value (<0.0001). Oswestry disability score and index showed a good improvement in the quality of life with a p value < 0.0001. The Beck index did not show a significant change postoperatively. Complications encountered were cement extravasation into venous pathway, cement extravasation into the soft tissue, cement extravasation into the needle tract, and adjacent vertebral fractures. No major complication was encountered.
Conclusion: Vertebroplasty provides better pain relief, improved function, and quality of life than conservative management. Use of an appropriate technique will improve the overall success rate of the procedure and minimize the complications.
Clinical significance: For patients with osteoporotic fractures who do not respond to conservative measures, vertebroplasty is a simple, effective, and minimally invasive procedure providing adequate pain relief and improving the quality of life.
Cohen LD. Fractures ofthe osteoporotic spine. Orthop Clin North Am 1990;21(1):143–150.
Lamy O, Uebelhart B, Aubry-Rozier B. Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures. Osteoporos Int 2014;25(3):807–819. DOI: 10.1007/s00198-013-2574-4.
Silverman SL. The clinical consequences of vertebral compression fracture. Bone 1992;13:S27–S31. DOI: 10.1016/8756-3282(92)90193-z.
Teyssédou S, Saget M, Pries P. Kyphopasty and vertebroplasty. Orthop Traumatol Surg Res 2014;100(1 Suppl):S169–S179. DOI: 10.1016/j.otsr.2013.11.005.
Cotten A, Boutry N, Cortet B, et al. Percutaneous vertebroplasty: State of the art. Radiographics 1998;18(2):311–320. DOI: 10.1148/radiographics.18.2.9536480; discussion,320–323.
Deramond H, Depriester C, Galibert P, et al. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 1998;36(3):533–546. DOI: 10.1016/s0033-8389(05)70042-7.
Martin JB, Jean B, Sugiu K, et al. Clinical experience and follow-up results. Bone 1999;25(2):11S–15S. DOI: 10.1016/s8756-3282(99)00126-x.
Barr M, Barr J. Invitedcommentary. Radiographics 1998;18:320–322.
Cotten A, Deramond H, Cortet B. Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas. Am J Nuclear Res 1996;17(1):137–142.
Cotten A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 1996;200(2):525–530. DOI: 10.1148/radiology.200.2.8685351.
Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 1987;33:166–168.
Yuan W-H, Hsu H-C, Lai K-L. Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures a meta-analysis. Medicine 2016;95(31):e4491. DOI: 10.1097/MD.0000000000004491.
Ateş A, Gemalmaz HC, Deveci MA, et al. Comparison of effectiveness of kyphoplasty and vertebroplasty in patients with osteoporotic vertebra fractures. Acta Orthop Traumatol Turc 2016;50(6):619–622. DOI: 10.1016/j.aott.2016.10.002.
Baerlocher MO, Saad WE, Dariushnia S, et al. Society of interventional radiology standards of practice committee. Quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol 2014;25(2):165–170. DOI: 10.1016/j.jvir.2013.09.004.
Tsoumakidou G, Too CW, Koch G, et al. CIRSE guidelines on percutaneous vertebral augmentation. Cardiovasc Intervent Radiol 2017;40(3):331–342. DOI: 10.1007/s00270-017-1574-8.
Higgins KB, Harten RD, Langrana NA, et al. Biomechanical effects of unipedicular vertebroplasty onintact vertebrae. Spine (Phila Pa 1976) 2003;28(14):1540–1547. DOI: 10.1097/01.BRS.0000076822.61468.7D; discussion 1548.
Lamanna A, Maingard J, Kok HK, et al. Vertebroplasty for acute painful osteoporotic vertebral compression fractures: an update. J Med Imaging Radiat Oncol 2019;63(6):779–785. DOI: 10.1111/1754-9485.12900.
Nieuwenhuijse MJ, Bollen L, van Erkel AR, et al. Optimal intravertebral cement volume in percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures. Spine 2012;37(20): 1747–1755. DOI: 10.1097/BRS.0b013e318254871c.
Kwon HM, Lee SP, Baek JW, et al. Appropriate cement volume in vertebroplasty: a multivariate analysis with short-term follow-up. Korean Neurotrauma 2016;12(2):128. DOI: 10.13004/kjnt.2016.12.2.128.
Jin YJ, Yoon SH, Park K-W. The volume tricanalysis of cementin vertebroplasty: Relationship with clinical out comeand complications. Spine 2011;36(12):E761–E772. DOI: 10.1097/BRS.0b013e3181fc914e.
Clark W, Bird P, Petal G. Safety and efficacy of vertebroplasty foracute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016;388(10052): 1408–1416. DOI: 10.1016/S0140-6736(16)31341-1.
Jensen ME, Kallmes DF, Short JG, et al., Percutaneous vertebroplasty doesnot increase the risk of adjacent level fracture: aretrospectivestudy (abstr). In: ASNR Annual Meeting Program. Oak Brook, Ill: American Society of Neuroradiology, 2000;4.
Lin EP, Ekholm S, Hiwatashi A, et al. Vertebroplasty: Cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 2004;25(2):175–180.