Article
High-quality biplane digital fluoroscopy allows vertebroplasty in high-risk patients – a prospective study
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Authors
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Mark Klingenhöfer
- Klinik für Neurochirurgie, Westfälische Wilhelms-Universität, Münster, Deutschland
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Sven Eicker
- Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Bernd Turowski
- Institut für Neuroradiologie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Hans-Jakob Steiger
- Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Walter Stummer
- Klinik für Neurochirurgie, Westfälische Wilhelms-Universität, Münster, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: Vertebroplasty is a technique for stabilizing vertebral bodies by injection of bone cement. Gallibert and Deramont described this technique for painful hemangiomas in 1987. After good results, the indication for vertebroplasty was extended to other diseases. However, especially in the treatment of metastases, the risk of clinically symptomatic cement leakage can be as high as 10%.
Methods: We present a prospective study with 167 patients. In 259 consecutive vertebral bodies vertebroplasty was performed under high-resolution biplane digital fluoroscopy. The indications for vertebroplasty were pain caused by 13 haemangiomas, 30 myelomas, 45 metastases and 171 osteoporotic fractures. In 67 patients the dorsal wall of the vertebral bodies was destroyed. Via a transpedicular route under local anesthesia or an open anterior approach for C2 2.9ml (±1.6 ml) of bone cement were injected into the vertebral bodies.
Results: No clinically relevant complications were observed. 14% of treated segments showed cement leakage into small veins and in 3.9% patients asymptomatic cement leakage into the spinal canal. 13.5% of the segments and especially segments with metastases showed cement leakage into the disc. The mean pain level, measured with the visual analogue scale, could be reduced from 6.6 to 1.8 one week after surgery.
Conclusions: Vertebroplasty under high-resolution biplane digital fluoroscopy is an effective and safe treatment for reducing pain for high risk patients. Osteolytic destruction of the vertebral body and the dorsal border do not appear to be contraindications in this setting.
