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5 - Percutaneous Vertebroplasty

from PART I - LOCOREGIONAL PAIN CONTROL

Published online by Cambridge University Press:  04 September 2009

By
Mitchell T. Smith
Edited by
Charles E. Ray, Jr.
Charles E. Ray, Jr.
Affiliation:
Denver Health Medical Center
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Summary

INTRODUCTION

The first percutaneous vertebroplasty (PVP) using imaging guidance was performed in France in 1984 (1). The injection of polymethylmethacrylate (PMMA) by Galibert et al. into a painful C2 hemangioma relieved the patient's pain (1). Since that time, the interest and technical efficacy have improved to the point where PVP is used to treat osteoporotic and malignant compression fractures as well as primary and metastatic neoplasms of the vertebral bodies at all levels.

Prior to the development of PVP, painful vertebral compression fractures (VCFs) were treated conservatively. Indeed, current recommendations for PVP include failure of conservative treatment as a procedural prerequisite. The initial treatment of patients with painful VCF is a combination of immobilization, external bracing, and analgesic drugs (2).

Many pharmacological therapies are aimed at preventing the bone demineralization that can lead to compression fracture. The commonly prescribed medications include bisphosphonates, alendronate, and risedronate, which bind to hydroxyapetite and inhibit resorption. These agents are usually well tolerated and available in once weekly preparations (3,4). Calcitonin, administered as a nasal spray, prevents osteoclast-mediated bone resorption and may have analgesic properties. Finally, teriparatide, a truncation product of human parathyroid hormone, stimulates bone formation and is available for subcutaneous injection. The use of these agents can decrease the incidence of VCFs by 60% in one year (5,6).

Surgical intervention is needed in a small percentage of patients with VCFs. This is usually secondary to a neurological deficit resulting from the fracture deformity.

Type
Chapter
Information
Pain Management in Interventional Radiology , pp. 43 - 57
Publisher: Cambridge University Press
Print publication year: 2008

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