vertebroplasty

Vertebroplasty is an imaging-guided procedure which entails percutaneous injection of surgical polymethylmethacrylate (PMMA) cement into a diseased vertebral body. Vertebroplasty provides pain relief and strengthening of the bone of vertebrae weakened by disease.

Indications

It can be used as a treatment or as a palliative measure for:

• insufficiency fracture
• aggressive hemangioma
• vertebral multiple myeloma
• vertebral metastases

Contraindications

Absolute contraindications

• septicemia
• active osteomyelitis of the target vertebra
• uncorrectable coagulopathy
• allergy to bone cement or opacifying agent

Relative contraindications

• radiculopathy beyond local vertebral pain, caused by a compressive syndrome unrelated to vertebral collapse
  • occasionally, preoperative vertebroplasty can be performed before a spinal decompressive procedure
• retropulsion of a fracture fragment or epidural tumor extension causing signs and symptoms of neurological compromise
• current systemic infection
• patient improving on medical therapy
• prophylaxis in osteoporotic patients
• myelopathy or cauda equina syndrome originating at the fracture level

Complications

• leakage of vertebroplasty
  • compression of adjacent structures
  • inferior vena cava syndrome
• cement extravasation
  • extravasation into paravertebral veins
  • cement pulmonary embolism