Vertebroplasty

1. Vertebroplasty • A technique of Percutaneous Injection under Fluoroscopic Guidance of Methyl Methacrylate polymer into a weakened Vertebral body to relieve pain.

2. Vertebroplasty • Originated in France – 1986 • 70-90% pain relief • 1% risk of complications

3. The Osteoporotic Vertebral Fracture

4. Advantages of Vertebroplasty • Provides rapid reduction of Pain which has been resistant to Drug treatment. • Bone strengthening • Prevention of Vertebral Collapse • Less Invasive than conventional surgery

5. Patient Selection • Within 4 months of fracture • Axial midline pain refractory to conservative measures • Increased on loading • Local tenderness over spinous process • MRI shows altered signal in body • 2/3 of fractures are painless

6. Results • Significant pain relief is seen in 75-90% of osteoporotic fractures • And in 59-86% of malignant fractures. • Increased mobility • Reduced analgesic requirement • Results are sustained over time

7. Mechanism of Pain Relief • Destruction of sensitive nerve endings by mechanical, chemical and thermal forces. • Stabilization of microfractures and reduction of destabilizing mechanical forces.

8. Guide wire insertion

11. Neuralgia Infection Cord compression Pulmonary Embolism Vascular injury - haematoma Rib fractures CSF leakage Hypotension Increased pain Complications - < 10%

13. Vertebroplasty--Complications • Incidence of complications is greater in Metastatic lesions as compared to Osteoporotic vertebral fractures.

14. Vertebroplasty-Results • 47 patients • 92 vertebral levels • Osteoporosis-39 • Metastatic tumours-10 • Ca. lung, Multiple myeloma • Renal Cell Ca., Transitional cell Ca. • Lymphoma

15. Vertebroplasty-Results • 90% had significant relief in pain • Sustained pain relief

16. Vertebroplast-Results • 5 Patients-Transpedicular Biopsy and simultaneous Vertebroplasty through opposite pedicle • Lymphoma(Diagnosed on Biopsy) • Osteoporotic fracture(h/o of Uterine & Breast Ca.ruled out)

17. Thank you