Vertebroplasty What's New

The first percutaneous injection of bone cement into the spine was performed in 1984 by Dr. H. Deramond (Amiens, France) to treat a 54 year old woman with extreme pain caused by a haemangioma in the second cervical vertebra. Surprisingly, pain relief was complete. After the case was published, indications for percutaneous vertebroplasty quickly expanded to include treatment of chronic back pain caused by metastases and osteoporotic fracture. Since then, many case series (Without randomization) have indicated that vertebroplasty is an effective way to control the pain of vertebral compression fracture caused by osteoporosis (figure 1). Educational Objectives in this presentation: • To show the new randomized double blind multicentre studies • Discuss the utility of vertebroplasty to treat osteoporosis • Identify ideal candidates for Vertebroplasty • Discuss the future of vertebroplasty • In our department we tried since the beginning (1995) of the Vertebroplasty procedure in our hospital to start with a double blind multicentre randomized study. VERTOS I. 1 In this study 34 patients were randomized (18 Vertebroplasty-16 CT (conservative therapy)) recent osteoporotic fracture 6w-6m. with bone marrow oedema on Mirth patients improvement in the vertebroplasty group was fairly consistent so that all the patient of the other group went in crossover after 2 weeks (14/16 from CT to V ).The follow up was 2 weeks and the VAS pain score 8,2 +/–1,21 → 2,1 +/– 1,91(1week) • This small randomized trial showed that vertebroplasty reduced disability and improved quality of life at 2 weeks compared with non-surgical treatment, but the crossovers preclude long-term comparisons. • The results are fairly consistent, and in a new large review of 534 patients, improvement in pain and disability persisted throughout one years of follow-up. Unfortunately we lost the most of the patient during our follow–up. After one Year we could review 124 patient in comparison with the conservative treated patient (128 – 89 p). • The Non-Randomized Review of osteoporotic fracture treatments • (n= 534 → 124 patients with osteoporosis T score: –2,5 equal in both groups(1995-2008) 76% VP/ 24% CMT(128 → 89).Age > 40–85Y.68% Lumbar spine. 32%. Thoracic spine. 89% women / 11 % Men. 475 women 73,4Y – 58.men 78,3y. Average 24d fracture (Type A1–3.1) equal in both groups.1,3 fracture/p with bone oedema. Treatment for Local back pain 6 weeks or less. Bone marrow oedema (MRI).