[Percutaneous vertebroplasty -- the role of osseous phlebography].
OBJECTIVE
To evaluate the usefulness of osseous phlebography preceding percutaneous vertebroplasty.


METHODS
Seventy-five patients with painful osteoporotic (57) or malignant (18) vertebral fractures were treated by percutaneous vertebroplasty under fluoroscopic control. Prior to cement injection, osseous phlebography was performed, with 247 phlebographic studies included in the retrospective correlation with radiographic and CT images. Clinical results were assessed by standardized questionnaire.


RESULTS
In 69/75 (92 %) patients, pain and mobility improved and medication needed for pain control decreased significantly after vertebroplasty. Two clinically apparent complications occurred. The results of osseous phlebography prompted correction of the needle position in 34/247 (14 %) of the procedures and cancellation of the cement injection in 19/247 (8 %). No complications occurred related to osseous phlebography. CT was superior to conventional radiography in detecting extra-osseous cement leakage (106/247 by CT vs. 63/247 by conventional radiography). The cement leakage was asymptomatic in 104/106 (98 %) cases for the duration of follow-up.


CONCLUSIONS
Osseous phlebography prior to percutaneous vertebroplasty had a significant impact on the procedure in our retrospective study and was able to predict the cement distribution in the majority of cases. However, phlebography was unable to foresee and therefore prevent 2 clinically relevant complications. Complications related to phlebography did not occur.
Hierholzer
J
J
Diagnostische und Interventionelle Radiologie, Klinikum Ernst-von-Bergmann gGmbH, Potsdam. jhierholzer@klinikumevb.de
Fuchs
H
H
Westphalen
K
K
Venz
S
S
Pappert
D
D
Depriester
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001416:Back Pain / Q000209:etiology / Q000517:prevention & control; D001843:Bone Cements / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D005260:Female; D005471:Fluoroscopy; D005598:Fractures, Spontaneous; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010024:Osteoporosis / Q000150:complications; D010690:Phlebography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D001843:Bone Cements