Back stab Percutaneous vertebroplasty for severe back pain

• Published in: Canadian family physician Vol. 53; no. 7; pp. 1169 - 1175
• Main Authors: Banerjee, Susitna, Baerlocher, Mark Otto, Asch, Murray R
• Format: Journal Article
• Language: English
• Published: Canada The College of Family Physicians of Canada 01.07.2007; College of Family Physicians of Canada
• Subjects: Back Pain - diagnosis; Back Pain - therapy; Bone Cements; Clinical Review; Female; Follow-Up Studies; Humans; Injections, Spinal; Lumbar Vertebrae - drug effects; Male; Pain Measurement; Pain, Intractable - diagnosis; Pain, Intractable - therapy; Patient Selection; Polymethyl Methacrylate - pharmacology; Polymethyl Methacrylate - therapeutic use; Risk Assessment; Severity of Illness Index; Treatment Outcome
• ISSN: 0008-350X; 1715-5258

To review the evidence supporting use of percutaneous vertebroplasty for relief of pain and mechanical stability in patients with vertebral compression fractures unrelieved by conventional measures. Ovid MEDLINE was searched from January 1966 to December2006 for all English-language papers on vertebroplasty. The quality of evidence in these papers was graded according to the 4-point classification system of evidence-based medicine. Level II evidence currently supports use of vertebroplasty. Vertebroplasty alleviates pain from vertebral compression fractures that result from osteoporosis, hemangiomas, malignancies, and vertebral osteonecrosis. Vertebroplasty has provided substantial pain relief in 60% to 100% of patients; has decreasedanalgesic use in 34% to 91% of patients; and has improved physical mobility in 29% to 100% of patients. Contraindications to vertebroplasty include asymptomatic compression fractures of the vertebral body, vertebra plana, retropulsed bone fragments or tumours, active infection, uncorrectable coagulopathy, allergy to the bone cement or opacification agent, severe cardiopulmonary disease, pregnancy, and pre-existing radiculopathy. The short-term complication rate was found to be 0.5% to 54%. Rare but serious complications include compression of the spinal cord or nerve root, infection, cement embolization causing pulmonary infarct and clinical symptoms, paradoxical embolization of the cerebral artery, and severe hematomas. Vertebroplasty is a safe and effective treatment for vertebral fractures that cannot be treated using conservative measures.