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Results

Between 1990 and 2002, 868 percutaneous cementoplasty were performed in our institution. Indications were severe painful osteoporosis, vertebral tumors, and symptomatic hemangiomas. 663 Patients(mean: 1.3 vertebra/patient) were performed. The age of patients ranged between 25-86 years. The indications for vertebroplasty were severe painful osteoporosis (57% of cases), vertebral body tumors (37% of cases), symptomatic vertebral hemangiomata (6% of cases).  The good pain relief obtained with this technique is not correlated with the volume of glue injected, especially in metastasis where 1.5 ml of glue is usually enough to reduce considerably the patient's pain.). The average volume of cement injected was 2.8 ml (ranging from 1.8 to 6.5 ml). The analgesic effect appeared within 6 to 48 hours after procedure. For pain management the results were evaluated according to the reduction of opiate analgesic doses (table below ). Satisfactory results (pain score > 2)were obtained in 73% to 87% of the cases (depending on the indication). Other studies agree that Percutaneous cementoplasty is safe and effective technique ( 14, 17, 20, 22, 37 ).

Percutaneous cementoplasty is a successful technique for pain management and consolidation of pathologic vertebral bodies.

  • The most critical elements for successful vertebroplasty are proper patient selection, correct needle placement; good timing of cement injection, strict fluoroscopy control of injection, and operator's experience. The good pain relief obtained with this technique is not correlated with the volume of glue injected, especially in metastasis where 1.5 ml of glue is usually enough to reduce considerably the patient's pain.
  • in the global series of 868 cementoplasties, an epidural leak was observed in 15 cases which causes neuralgia only in three cases without spinal cord compression. Spinal cord compression is an emergency and urgent surgery is mandatory to avoid neurological complications. The injection of acrylic cement should be performed under a high-quality fluoroscopy unit. The injection is immediately interrupted if the cement reaches the posterior cortex of the vertebral body. Adequate radio-opacity of acrylic glue (with the addition of tantalum, barium or tungsten) is mandatory and the cement should be injected during its pasty polymerization phase. Radiculopathy is the major risk with neural foramina leaks. The radiculopathy is particularly difficult to treat at the cervical and lumbar levels. Epidural vein filling does not necessarily cause neuralgia. Significant cement leaks towards the disk were observed in 15 cases. However these leaks were without clinical consequence although the risk of adjacent vertebral collapse is increased.
  • In two cases, an asymptomatic pulmonary embolism was detected. In both cases, paravertebral venous opacification was observed. To avoid major pulmonary infarction, the glue should be injected slowly during its pasty polymerization phase under fluoroscopy control and the injection should immediately be stopped if venous leak is observed.
  • In one case, the hardening of glue did not allow the reinsertion of the stylet of the needle. After the needle was pulled out, a paravertebral cement leak was detected. Two days later, the glue fragment was extracted percutaneously. The stylet should be repositioned before removal of the needle whenever possible in all cases. If the stylet could not be reinserted, the needle is removed under fluoroscopy control to detect leak.
  • In one case, an asymptomatic intercostal artery injection occurred during vertebroplasty of a hypervascularized breast cancer metastasis. Thus, hypervascularized lesion should be evaluated by phlebogram in anteroposterior and lateral views before cementoplasty particularly in dorsolumbar region (T11 -L1).

ANALGESIC SCORE DEFINITION

Score
Definition
1
little or no relief
2
moderate relief ( 25% to 50% reduction of analgesic doses)
3
very good but incomplete relief (75% reduction of analgesic doses)
4
complete relief