Percutaneous vertebroplasty: new treatment for vertebral compression fractures.

Interventional radiologists have been performing image-guided spinal procedures for many years. Percutaneous vertebroplasty is a newer technique in which a medical grade cement is injected though a needle into a painful fractured vertebral body. This stabilizes the fracture, allowing most patients to discontinue or significantly decrease analgesics and resume normal activity. The impact of this procedure on the morbidity and expense associated with symptomatic osteoporotic vertebral compression fractures in the United States may be significant. Patients who are unresponsive to conservative therapy of bed rest, analgesics, and back bracing should be considered for vertebroplasty. This procedure is contraindicated in patients with active infection, untreated coagulopathy, and certain types of fracture morphology. Because many patients have multiple chronic fractures, there should be a strong correlation between the physical examination signs, symptoms, and cross-sectional imaging findings. The success rate for this procedure in treating osteoporotic fractures is 73 to 90 percent. Vertebroplasty can effectively treat aggressive hemangiomas of the vertebral body and may be palliative in patients with malignant pathologic fractures. Significant complications of the procedure are less than 1 percent.