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vertebroplasty

Also see kyphoplasty. Indications: - vertebral compression fractures due to osteoporosis a) *complete pain relief in 50% [1,2] b) no better than placebo (sham operation) [3] c) useful with loss of > 2/3 vertebral height [1,2] d) beneficial only within 3 weeks of fracture & only for fractures at T11-L2 [7] e) not recommended as 1st line therapy [5] * of questionable value [8] Procedure: 1) percutaneous procedure with analgesia 2) performed by interventional radiologist 1) a trocar is inserted through the vertebral pedicle & into the marrow of the vertebral body under fluoroscopic guidance 2) polymethylmethacrylate cement is injected into the vertebral body where it hardens Complications: - vertebroplasty associated with 25% increased likelihood of opioid therapy after 30 days (relative to sham) [5] - not associated with increased risk of secondary fractures [8] Notes: - utilization of vertebroplasty & kyphoplasty may be declining [6]

Related

kyphoplasty (balloon kyphoplasty)

General

vertebral augmentation

References

  1. Journal Watch 22(10):82, 2002 Peh WCG et al Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 223:121, 2002 PMID: 11930056
  2. Journal Watch 23(6):49, 2003 Evans AJ et al Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology 226:366, 2003 PMID: 12563127
  3. Buchbinder R et al, A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures N Eng J Med 361:557-568 August 6, 2009 PMID: 19657121 http://content.nejm.org/cgi/content/short/361/6/557 - Kallmes DF et al, A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures N Eng J Med 361:569-579 August 6, 2009 N Engl J Med. 2009 http://content.nejm.org/cgi/content/short/361/6/569 - Weinstein JN Balancing Science and Informed Choice in Decisions about Vertebroplasty N Eng J Med 361:619-621 August 6, 2009 PMID: 19657127 http://content.nejm.org/cgi/content/full/361/6/619
  4. Klazen CAH et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): An open-label randomised trial. Lancet 2010 Aug 10 PMID: 20701962
  5. Staples MP et al Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: Meta-analysis. BMJ 2011 Jul 12; 343:d395 PMID: 21750078 - Wilson DJ. Vertebroplasty for vertebral fracture: On the basis of current evidence, cannot be recommended as the first line treatment. BMJ 2011 Jul 12; 343:d3470 PMID: 21750076
  6. Long SS et al. Vertebroplasty and kyphoplasty in the United States: Provider distribution and guidance method, 2001-2010. AJR Am J Roentgenol 2012 Dec; 199:1358. PMID: 23169730
  7. Clark W, Bird P, Gonski P, Diamond TH et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): A multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016 Aug 17; PMID: 27544377 - Hirsch JA, Chandra RV. Resurrection of evidence for vertebroplasty? Lancet 2016 Aug 17 PMID: 27544375
  8. Mills ES et al. Secondary fracture rate after vertebral osteoporotic compression fracture is decreased by anti-osteoporotic medication but not increased by cement augmentation. J Bone Joint Surg Am 2022 Dec 21; 104:2178 PMID: 36223482 https://journals.lww.com/jbjsjournal/Abstract/2022/12210/Secondary_Fracture_Rate_After_Vertebral.6.aspx