Vertebroplasty

1
Vertebroplasty

• A technique of Percutaneous Injection under
  Fluoroscopic Guidance of
• Methyl Methacrylate polymer into a weakened
  Vertebral body to relieve pain.

2
Vertebroplasty

• Originated in France 1986
• 70-90 pain relief
• 1 risk of complications

3
The Osteoporotic Vertebral Fracture
4
Advantages of Vertebroplasty

• Provides rapid reduction of Pain which has been
  resistant to Drug treatment.
• Bone strengthening
• Prevention of Vertebral Collapse
• Less Invasive than conventional surgery

5
Patient Selection

• Within 4 months of fracture
• Axial midline pain refractory to conservative
  measures
• Increased on loading
• Local tenderness over spinous process
• MRI shows altered signal in body
• 2/3 of fractures are painless

6
Results

• Significant pain relief is seen in 75-90 of
  osteoporotic fractures
• And in 59-86 of malignant fractures.
• Increased mobility
• Reduced analgesic requirement
• Results are sustained over time

7
Mechanism of Pain Relief

• Destruction of sensitive nerve endings by
  mechanical, chemical and thermal forces.
• Stabilization of microfractures and reduction of
  destabilizing mechanical forces.

8
Guide wire insertion
9
(No Transcript)
10
(No Transcript)
11
Complications - lt 10

• Neuralgia
• Infection
• Cord compression
• Pulmonary Embolism
• Vascular injury - haematoma

• Rib fractures
• CSF leakage
• Hypotension
• Increased pain

12
(No Transcript)
13
Vertebroplasty--Complications

• Incidence of complications is greater in
  Metastatic lesions as compared to Osteoporotic
  vertebral fractures.

14
Vertebroplasty-Results

• 47 patients
• 92 vertebral levels
• Osteoporosis-39
• Metastatic tumours-10
• Ca. lung, Multiple myeloma
• Renal Cell Ca., Transitional cell Ca.
• Lymphoma

15
Vertebroplasty-Results

• 90 had significant relief in pain
• Sustained pain relief

16
Vertebroplast-Results

• 5 Patients-Transpedicular Biopsy and simultaneous
  Vertebroplasty through opposite pedicle
• Lymphoma(Diagnosed on Biopsy)
• Osteoporotic fracture(h/o of Uterine Breast
  Ca.ruled out)

17
Thank you