Abstract
The utility of vertebroplasty in the treatment of spinal pain has been accepted worldwide. In this co-operative study we show the success and failure rates related to the pathological condition treated (porotic, metastatic or angioma), the incidence of new vertebral fractures adjiacent to the previously treated one, and the incidence of symptomatic and asymptomatic side effects.
In all, 898 patients were treated from April 2001 through January 2004 for a total of 1796 vertebral bodies. Of these, 654 patients (73%) were treated for porotic abnormalities, 213 patients (24%) had neoplastic disease and 27 patients (3%) presented with compressive or painful angioma. Different types of cement were used. All patients were treated after MR and CT examination or, as an alternative to MR, bone nuclear medicine scan, always associated with clinical evaluation. The patients were treated under CT and C-arm fluoroscopy control (2 centres) or under fluoroscopy in an angiography suite (five centres). We never perfomed general anaesthesia, only local sedation or administration of neuroleptic drugs. Blood tests were always performed before the treatment to exclude coagulopathy. Only the presence of local or systemic infection was considered to be a real contraindication.
We had a 93% success rate in patients with porotic abnormalities, one of 73% in patients with neoplastic disease and of 100% in patients with angioma. Asymptomatic venous leak was seen in 135 patients (15%) and CT demonstrated asymptomatic pulmonary embolus in eight patients (0.9%). No symptomatic venous and pulmonary emboli were identified. New fractures adjacent to a previously treated vertebral body developed in 14 patients (1.3%) while six patients showed radiculopathy (0.6%) due to posterior leakage in the lateral lumbar recess that was treated and resolved with medical therapy in 3 weeks. In six patients we also had psoas haematoma treated with medical therapy; no instance of cord compression was found. Mild disc leakage developed in 90 patients (10%) but we did not find any relation with new adjacent vertebral fracture.
Vertebroplasty represents a safe technique in the treatment of spinal pain related to porotic, neoplastic changes or angioma. The technique must be performed with high performance technology. The incidence of symptomatic effects and new fractures related to previously treated vertebrae or disc leakage is very low.
