Volume 15 | Issue 2 | Apr-Jun 2020 | Page 16-21 | Sanjeev Motilal Bhandari, Siddharth Sanjeev Bhandari, Mahadeo Manaji Ghuge
Authers: Sanjeev Motilal Bhandari , Siddharth Sanjeev Bhandari , Mahadeo Manaji Ghuge 
 Department of Orthopaedics, Dr.V.M.Government Medical College, Solapur.
Address of Correspondence
Dr. Sanjeev Motilal Bhandari
Department of Orthopaedics,
Bhandari Hospital, 146, Railway Lines,
Solapur – 413001 ( Maharashtra ) India
Background: Percutaneous Vertebroplasty (PVP) is an established procedure for vertebral compression fractures (VCF) in elderly due to osteoporosis and vertebral neoplasms. Here we want to share a few practical tips for good results, avoiding potential complications.
Materials & Methods: 156 patients having 172 VCFs, not responding to conservative treatment, were included in this prospective study from 2012 to 2019. Under local anesthesia, bipedicular entry was taken over 2 mm guide wires using Jamshidi needles. After core biopsy in doubtful aetiology, about 3 to 5 ml of pre-cooled PMMA cement was injected, after contrast injection to check for any leakage. The mean duration of follow-up was 16.2 months, ranging from minimum 12 months to 8 years. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate pain relief after PVP.
Results: All patients had immediate relief from disabling pain and could be mobilized immediately. VAS Score improved from mean pre-PVP score of 7.8 (range 6-9) to 2.8 (range 0-5) and 3.2 (range 0-6) at 1 week and 1 year postoperative respectively. Similarly ODI improved from 72% to 29% at 1 year follow-up. The complication rate was 6.3%, which included cement leakage (2.5%; n=4), suboptimal cement filling (2.5%; n=4), deep infection (0.64%; n=1) and late cement extrusion in canal (0.64%; n=1).
Conclusions: For VCFs, PVP is a cost-effective minimally invasive procedure with immediate pain relief and low incidence of complications. Employing a few modifications in technique, the complications can be further reduced with uniform good results.
Keywords: Vertebral fractures, Percutaneous vertebroplasty, Guide wire, Bipedicular technique, Contrast injection
1. Heran MK, Legiehn GM, Munk PL. Current concepts and techniques in percutaneous vertebroplasty. Orthop Clin North Am. 2006;37(3):409–434.
2. Galibert P, Deramond H, Rosat P, Le Gars D. Note préliminaire sur le traitement des angiomesvertébraux par vertébroplastieacryliquepercutanée [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie. 1987;33(2):166–168.
3. Gangi A, Kastler BA, Dietemann JL. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. Am J Neuroradiol. 1994;15(1):83–86.
4. Cotten A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology. 1996;200(2):525–530.
5. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. Am J Neuroradiol. 1997;18(10):1897–1904.
6. Cortet B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, Delcambre B.Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol. 1999;26(10):2222–2228.
7. Legroux-Gérot I, Lormeau C, Boutry N, Cotten A, Duquesnoy B, Cortet B. Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Clin Rheumatol. 2004;23. 310–317.
8. Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376(9746):1085–1092.
9. Nakamae T, Fujimoto Y, Yamada K, Hashimoto T, Olmarker K. Efficacy of Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft. Open Orthop J. 2015;9:107–113.
10. Lane JM, Johnson CE, Khan SN, Girardi FP, Cammissa FP. Minimallyinvasive options for the treatment of osteoporotic vertebral compression fractures. Orthop Clinics N. America. 33 (2002) : 431 – 38.
11. Lieberman IH, Dudeney S, Reinhardt MK, Bell G. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976).2001;26(14):1631–1638.
12. Shi-Meng G,Wen-Juan L,Yun-Mei H, Yin-Sheng W, Mei-Ya H, Yan-Ping L. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for osteoporotic vertebral compression fracture A metaanalysis. Indian J Orthop2015;49:377-87.
13. Hoyt D, Urits I, Orhurhu V, et al. Current Concepts in the Management of Vertebral Compression Fractures. Curr Pain Headache Rep. 2020;24(5):16.
14. Phillips FM. Minimally Invasive Treatments of Osteoporotic Vertebral Compression Fractures. Spine 2003;28. 15Suppl: S45-S53.
15. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361(6):569–579.
16. Buchbinder R, Johnston RV, Rischin KJ, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev. 2018;4(4):CD006349.
17. Kim DY, Lee SH, Jang JS, ChungSK, Lee HY. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability.JNeurosurg. 2004 Jan;100(1):24-31.
18. Wu AM, Chi YL, Ni WF. Vertebral compression fracture with intravertebral vacuum cleft sign: pathogenesis, image, and surgical intervention. Asian Spine J. 2013;7(2):148–155.
19. Chen YJ, Chen HY, Lo DF, Chen HT, Hsu HC. Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty: a technical report. Spine J. 2014;14(12):3025–3029.
20. Sun H, Li C. Comparison of unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2016;11(1):156.
21. Cheng Y, Liu Y. Percutaneous curved vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures. J Int Med Res. 2019;47(6):2424–2433.
22. Chavali R, Resijek R, Knight SK, Choi IS. Extending polymerization time of polymethylmethacrylate cement in percutaneous vertebroplasty with ice bath cooling. AJNR Am J Neuroradiol. 2003;24(3):545–546.
23. Lai PL, Tai CL, Chu IM, Fu TS, Chen LH, Chen WJ. Hypothermic manipulation of bone cement can extend the handling time during vertebroplasty. BMC MusculoskeletDisord. 2012;13:198.
|How to Cite this article: Bhandari S M, Bhandari S S, Ghuge M M. Percutaneous Vertebroplasty for Vertebral Compression Fractures – Practical Tips for Successful Outcome. Journal of Trauma and Orthopaedic Surgery. April – Jun 2020;15(2):16-21.|