Back Stab: Percutaneous Vertebroplasty for Severe Back Pain

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2007 Sep 18

PMID 17872813

Citations 1

Authors

Susitna Banerjee

Mark Otto Baerlocher

Murray R Asch

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Role of radiology in geriatric care: a primer for family physicians.

OBrien J, Baerlocher M, Asch M, Myers A Can Fam Physician. 2009; 55(1):32-7.

PMID: 19155363 PMC: 2628843.

References

Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P . Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford). 2001; 39(12):1410-4. DOI: 10.1093/rheumatology/39.12.1410. View

Mathis J . Percutaneous vertebroplasty or kyphoplasty: which one do I choose?. Skeletal Radiol. 2006; 35(9):629-31. DOI: 10.1007/s00256-006-0145-x. View

Predey T, Sewall L, Smith S . Percutaneous vertebroplasty: new treatment for vertebral compression fractures. Am Fam Physician. 2002; 66(4):611-5. View

McGraw J, Lippert J, Minkus K, Rami P, Davis T, Budzik R . Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol. 2002; 13(9 Pt 1):883-6. DOI: 10.1016/s1051-0443(07)61770-9. View

Evans A, Jensen M, Kip K, DeNardo A, Lawler G, Negin G . Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology. 2003; 226(2):366-72. DOI: 10.1148/radiol.2262010906. View

Kim D, Yun Y, Wang J . Nerve-root injections for the relief of pain in patients with osteoporotic vertebral fractures. J Bone Joint Surg Br. 2003; 85(2):250-3. DOI: 10.1302/0301-620x.85b2.13289. View

Winking M, Stahl J, Oertel M, Schnettler R, Boker D . Treatment of pain from osteoporotic vertebral collapse by percutaneous PMMA vertebroplasty. Acta Neurochir (Wien). 2004; 146(5):469-76. DOI: 10.1007/s00701-004-0259-7. View

McKiernan F, Faciszewski T, Jensen R . Quality of life following vertebroplasty. J Bone Joint Surg Am. 2004; 86(12):2600-6. DOI: 10.2106/00004623-200412000-00003. View

Kobayashi K, Shimoyama K, Nakamura K, Murata K . Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol. 2005; 15(2):360-7. DOI: 10.1007/s00330-004-2549-0. View

10.

Purkayastha S, Gupta A, Kapilamoorthy T, Kesavadas C, Thomas B, Krishnamoorthy T . Percutaneous vertebroplasty in the management of vertebral lesions. Neurol India. 2005; 53(2):167-72. DOI: 10.4103/0028-3886.16400. View

11.

Do H, Kim B, Marcellus M, Curtis L, Marks M . Prospective analysis of clinical outcomes after percutaneous vertebroplasty for painful osteoporotic vertebral body fractures. AJNR Am J Neuroradiol. 2005; 26(7):1623-8. PMC: 7975168. View

12.

Anselmetti G, Corgnier A, Debernardi F, Regge D . Treatment of painful compression vertebral fractures with vertebroplasty: results and complications. Radiol Med. 2005; 110(3):262-72. View

13.

Verlaan J, Oner F, Dhert W . Anterior spinal column augmentation with injectable bone cements. Biomaterials. 2005; 27(3):290-301. DOI: 10.1016/j.biomaterials.2005.07.028. View

14.

Prather H, Van Dillen L, Metzler J, Riew K, Gilula L . Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty. J Bone Joint Surg Am. 2006; 88(2):334-41. DOI: 10.2106/JBJS.D.02670. View

15.

Diamond T, Bryant C, Browne L, Clark W . Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust. 2006; 184(3):113-7. DOI: 10.5694/j.1326-5377.2006.tb00148.x. View

16.

Vogl T, Proschek D, Schwarz W, Mack M, Hochmuth K . CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures. Eur Radiol. 2005; 16(4):797-803. DOI: 10.1007/s00330-005-0021-4. View

17.

Hee H . Percutaneous vertebroplasty: current concepts and local experience. Neurol India. 2006; 53(4):475-82. DOI: 10.4103/0028-3886.22617. View

18.

Cheung G, Chow E, Holden L, Vidmar M, Danjoux C, Yee A . Percutaneous vertebroplasty in patients with intractable pain from osteoporotic or metastatic fractures: A prospective study using quality-of-life assessment. Can Assoc Radiol J. 2006; 57(1):13-21. View

19.

Zoarski G, Snow P, Olan W, Stallmeyer M, Dick B, Hebel J . Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol. 2002; 13(2 Pt 1):139-48. DOI: 10.1016/s1051-0443(07)61930-7. View