Vertebroplasty in osteoporosis disease

Osteoporosis is a common disease and is constantly increasing due to the rising average age of the human race. Many different treatments have been advocated to curb the effects of osteoporosis, but the current rate of vertebral collapse or back pain from osteoporosis remains high. Vertebroplasty is a percutaneous treatment for vertebral fractures and microfractures caused by osteoporosis, but can also be applied in the non-surgical and non-radiological treatment of painful or compressive osteo-angiomas and vertebral metastases. The technique consists of injecting acrylic cement into the vertebral bodies to stabilize and strengthen them and relieve pain. Vertebroplasty also leads to decompression of the dural sac and spinal cord in the case of painful or compressive osteo-angiomas. The treatment must be carried out under CT and/or fluoroscopic guidance using 8 or 11 G needles with a transpeduncular or trans-somatic approach, positioning the needle in the anterior III of the vertebral bodies. The cement is injected under fluoroscopic guidance in L-L view to have perfect control of the cement (made opaque by addition of sterile barium sulphate or other radio-opaque substances like tantalum) and to be sure to have an excellent control of the posterior wall which should never be penetrated during the injection. X-ray and CT follow-up show total or subtotal filling of the vertebral body and patients can be discharged 24 h after treatment. Side effects include epidural diffusion of the cement with secondary compression on the anterior CSF band and possible cord compression or even pulmonary embolism.