Percutaneous vertebroplasty - the first clinical experience in Moldova

Abstract

Background: Vertebroplasty is a minimally invasive, image-guided therapy used to relieve pain from a vertebral body fracture. Percutaneous vertebroplasty usually involves percutaneous injection of cement, polymethylmethacrylate into the vertebral bodies. It has been used for osteoporotic or malignant fractures. Initially, the major indication was treatment of spinal hemangiomas, as described in 1987 by Galibert et al. With experience, other indications have emerged. Vertebroplasty can increase patient mobility, decrease narcotic needs, and prevent further vertebral collapse. Objectives: There were 9 women and 6 men with a mean age of 64 years included. All patients had vertebral pain. Safe and accurate procedures of transpedicle vertebroplasty were examined, and the short-term results were evaluated. Methods for prevention of complications were also evaluated. Methods and results: Nineteen vertebral bodies were treated in 15 pacients. Bipediculate injections were used in 18 (94,7%) of 19 treatment levels, and unipediculate injections were used in 1 case (5,3% ) of treatments. The indications for vertebroplasty were hemangiomas in 7 patients, osteoporosis (osteoporotic fractures or severe osteoporosis of the vertebral body) in 6 patients, and malignant metastases in 2 patients. In 13 cases percutaneous vertebroplasty was performed. Open decompressive laminectomy with further vertebroplasty were performed in 1 patient with vertebral compression fracture. A transoral vertebroplasty for a fractured C2 vertebra, caused by an angiosarcoma metastasis, was also performed in 1 patient. Neurologic or systemic complications, such as pulmonary embolism, were not observed. After surgery, no aggravation of pain was observed, and pain was alleviated in all 15 patients. The mean visual analog scale (VAS) score was 7.2 points before surgery and 1.3 points after surgery. Al these 15 patients could walk by themselves on the day of or next day after surgery. Conclusions: Percutaneous vertebroplasty proved to be safe and effective in reducing pain and improving functional status of patients with specific vertebral body lesions (osteoporotic vertebral fracture, vertebral hemangioma, spinal tumors). It provides significant pain relief with the potential for improving functional outcome.