title: Endoscopic vertebroplasty for the treatment of chronic vertebral compression fracture. Technical note.
abstract: The authors describe a new vertebroplasty technique for the treatment of chronic painful vertebral compression fractures (VCFs). A urinary balloon catheter is introduced into the vertebral body (VB) via a bilateral transpedicular approach and inflated with contrast medium to obtain sufficient space for endoscopic observation. The granulation tissue occupying the VB is then removed using a punch or curette inserted through one pedicle, with the guidance of an endoscope introduced through the contralateral pedicle. After endoscopic resection of granulation tissue in the fractured VB, vertebroplasty is performed by injecting calcium phosphate cement (CPC) into the VB. Fourteen patients in whom chronic painful VCFs were diagnosed underwent surgery involving the aforementioned technique. In all cases, intractable pain and ambulatory function improved after surgery, and there were no significant systemic complications. On radiological evaluation in eight cases in which the follow-up period exceeded 1 year, the mean height of the fractured VB improved from 38% of that of adjacent intact VBs to 85%. Although a slight loss of correction was routinely observed at 1 month postoperatively, an additional loss of VB height was not noted up to 1 year later. Bone formation was commonly seen along the anterior wall of the involved vertebrae in all cases. Vertebroplasty involving the endoscopic removal of granulation tissue proved to be an efficacious procedure for the treatment of chronic painful VCFs. The osteoconductive capacity of CPC facilitated callus formation and ultimately restoration of vertebral bone structure.
authors.affiliation: Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hoshino
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Sadahiko
authors.initials: S
authors.lastname: Konishi
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Nagayama
authors.forename: Hidetomi
authors.initials: H
authors.lastname: Terai
authors.forename: Tadao
authors.initials: T
authors.lastname: Tsujio
authors.forename: Takashi
authors.initials: T
authors.lastname: Namikawa
authors.forename: Minori
authors.initials: M
authors.lastname: Kato
authors.forename: Kunio
authors.initials: K
authors.lastname: Takaoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D001843:Bone Cements; D002130:Calcium Phosphates / Q000008:administration & dosage; D002908:Chronic Disease; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008297:Male; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery
chemical_list: D001843:Bone Cements; D002130:Calcium Phosphates; C020243:calcium phosphate