Vertebroplasty Made Easy Arvind Bhave
INDEX
A
After percutaneous vertebroplasty 93
Anaesthesia 55
C
Cement leak 87
in the epidural space 87
in the foraminal region 86
in the spinal canal 86
in the veins 87
Cementing materials 19
Complications in vertebroplasty 81
Consequence of vertebral compression fractures 12
Contraindications for vertebroplasty 13
absolute 13
relative 13
D
Drapping and preparation 57
incision 60
point for infiltration for extrapedicular approach 59
E
European vertebral osteoporosis study group classification 32
I
Illustrative cases 97
Indications for vertebroplasty 12
absolute 12
relative 13
Interosseous venography 67
cement preparation 68
position of the needle 68
postoperative 71
venogram 68
Intervertebral pseudoarthrosis 38
avascular necrosis of vertebral body 38
K
Kyphoplasty 119
complications 122
contraindications 120
relative contraindication 120
indications 120
surgical steps 121
M
Most important five commandments to do vertebroplasty 74
Multilevel osteoporotic fractures 107
Multiple osteoporotic fractures 115
O
Osteoporotic vertebral compression fracture 5
conservative treatment 7
natural history 7
P
Paraparesis 93
Paraplegia 93
Patient evaluation and selection 16
clinical examination 16
CT scan 16
laboratory tests 16
MRI 16
X-rays 16
decompression theory 21
mechanical theory 20
thermal theory 21
Percutaneous vertebroplasty 2
PMMA cement related 82
Post vertebroplasty 114
Procedure of using the ‘AB needle for doing the vertebroplasty’—methods in transpedicular vertebroplasty 48
AB needle 48
advantages 48
monitoring 53
operating table 54
position of the patient 53
R
Review of literature 89
S
Surgical technique in vertebroplasty 47
T
T1 STIR T2 18
Tips and tricks: postural reduction 104
Tips to avoid the complications 84
V
Vertebra plana 113
Vertebral compression fractures 33
classification 33
biconcave deformity 34
crush 34
wedge compression 33
Vertebral fractures 23
anatomy 24
morphology 29
anterior wedging 30
codfish tail appearance 31
posterior wedging 32
site and units 32
whole body compression 31
Vertebral haemangioma 2
Vertebroplasty 2
development 2
history 2
Vertebroplasty in burst fractures 105
Vertebroplasty malignancies and bone tumours 45
Vertebroplasty—how does it work 20
Vesselplasty 127
concept 130
purpose 131
types of methods 128
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Chapter Notes

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IntroductionChapter 1

2
 
HISTORY AND DEVELOPMENT
Many years vertebroplasty is used as an open procedure to augment pedicular screw fixation during spinal instrumentation. The history suggests that the procedure was performed by Galibert and Deramond in the department of Radiology of the university hospital of Amiens, France.[Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral haemangioma by percutaneous vertebroplasty. Neurochirugie 1987;33:166–168 (French).] In 1984, on a 54 years woman who had severe neck pain with radiculopathy of C2 nerve root. The X-rays showed large vertebral haemangioma involving the C2 vertebral body. The C2 vertebra was injected percutaneously PMMA by a 15 G needle by an anterolateral approach. The patient had complete pain relief. Subsequently 6 patients were tried and the outcomes were published in 1987. Much experience was gained from the experimental work conducted on the fresh cadavers which could establish the technical parts of the procedure. On the basis of the work following points were established:
  1. Large bore 10 G needle can be used for the lumbar and thoracic vertebrae. Cervical spine would require 15 G needle.
  2. Addition of Tantalum to the cement [PMMA] to facilitate fluoroscopic visualisation of the cement during injection.
  3. Initially postero-lateral approach was devised for the trajectory but later on one case developed intercostals neuralgia because of cement leakage 3along the path of the needle, hence safer transpedicular approach was developed. This reduced the risk of cement leakage.
Later on the other doctors from the university hospital, Lyon, France used this surgery for weakened osteoporotic vertebrae of seven patients and in one with metastatic lesion and out of them six reported excellent results and one reported good results for pain relief. This procedure eventually was popularised in USA for vertebral compression fractures. [Jensen ME, Evans AJ, Mathis JM, et al. Percutaneous polymethyl methacrylate vertebroplasty in the treatment of osteoporotic vertebral fractures. Technical aspects. Am J Neuroradiol 1997;18:1897–1904].