Vertebroplasty

KEY FACTS

Terminology

• Percutaneous cement augmentation of vertebral body

Preprocedure

• STIR MR provides excellent depiction of bone marrow edema in acute fracture

• Clinical examination

  • Consistent with imaging findings

  • Point tenderness should be assessed prior to sedation

Procedure

• Can be performed with unipedicular or bipedicular access

  • Ensure that medial pedicle cortex is not violated

  • Use of mallet may be advantageous with nonthreaded access needles

  • Once needle is clearly within vertebral body on lateral view, switch to frontal and lateral views for further needle advancement

  • When needle is within anterior 1/3 of vertebral body, reassess position on direct AP and lateral fluoroscopy

• Inject polymethylmethacrylate (PMMA) cement under continuous fluoroscopy

  • Watch carefully for any signs of cement extravasation

  • Ensure that cement does not pass into posterior 1/4 of vertebral body on lateral view

Post Procedure

• Significant improvement in pain following vertebroplasty

  • May require narcotic analgesics and muscle relaxants

Outcomes

• Problems: Incomplete pain relief, increased incidence of fractures at adjacent levels

• Most feared complications

  • Spinal cord injury by direct puncture or compression

  • PMMA-induced anaphylaxis

  • Pulmonary PMMA cement embolism

TERMINOLOGY