Kyphoplasty: indications, contraindications and technique.
OBJECTIVE
Percutaneous Kyphoplasty is an emerging Interventional Radiology technique consisting in injecting polymethylmethacrylate (PMMA) into collapsed vertebral bodies under fluoroscopic guidance, after compaction of the cancellous bone with two dedicated balloon catheters. The purpose of our study was to assess the indications, contraindications, technique and results of our initial study.


METHODS
Between January and May 2003 we treated 11 patients (5 men, 6 women) with vertebral collapse occurred up to three months earlier and due to osteoporosis or myeloma (mean age: 68.9), with pain refractory to medical therapy. All patients underwent treatment on a single vertebra (1 D7; 1 D8; 2 D12; 3 L1; 3 L2; 1 L4). Patient selection was based on clinical and instrumental criteria: conventional radiography, CT and MR were performed on all patients before the procedure. The Visual Analogue Scale (VAS) for pain assessment was used to evaluate the post-procedure results.


RESULTS
All patients showed an increase in the height of the collapsed vertebral body, associated with partial or complete pain relief (VAS score decreasing from a pre-treatment score of 8 to a score of 2 after treatment). No complications related to the procedure were recorded.


CONCLUSIONS
The indications for kyphoplasty include recent vertebral compression fractures due to osteoporosis, myeloma, metastasis and vertebral angioma with intractable pain and with no neurological symptoms. The main contraindications are coagulation disorders, unstable fractures or complete vertebral collapse (vertebra plana). Kyphoplasty proved to be a safe and effective method for the treatment of intractable pain due to vertebral collapse that allows for shorter hospital stays and an immediate improvement in the patient's quality of life.
Masala
Salvatore
S
Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, Università degli Studi di Roma Tor Vergata, Rome. salva.masala@tiscali.it
Fiori
Roberto
R
Massari
Francesco
F
Simonetti
Giovanni
G
D000368:Aged; D001843:Bone Cements; D002404:Catheterization; D005260:Female; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000379:methods*; D005598:Fractures, Spontaneous / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications; D019637:Orthopedic Procedures; D010024:Osteoporosis / Q000150:complications; D010148:Intractable Pain / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D018579:Patient Selection; D019904:Polymethyl Methacrylate / Q000008:administration & dosage*; D015642:Radiology, Interventional; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D001843:Bone Cements; D019904:Polymethyl Methacrylate