Back stab: percutaneous vertebroplasty for severe back pain.
OBJECTIVE
To review the evidence supporting use of percutaneous vertebroplasty for relief of pain and mechanical stability in patients with vertebral compression fractures unrelieved by conventional measures.


METHODS
Ovid MEDLINE was searched from January 1966 to December2006 for all English-language papers on vertebroplasty. The quality of evidence in these papers was graded according to the 4-point classification system of evidence-based medicine. Level II evidence currently supports use of vertebroplasty.


RESULTS
Vertebroplasty alleviates pain from vertebral compression fractures that result from osteoporosis, hemangiomas, malignancies, and vertebral osteonecrosis. Vertebroplasty has provided substantial pain relief in 60% to 100% of patients; has decreasedanalgesic use in 34% to 91% of patients; and has improved physical mobility in 29% to 100% of patients. Contraindications to vertebroplasty include asymptomatic compression fractures of the vertebral body, vertebra plana, retropulsed bone fragments or tumours, active infection, uncorrectable coagulopathy, allergy to the bone cement or opacification agent, severe cardiopulmonary disease, pregnancy, and pre-existing radiculopathy. The short-term complication rate was found to be 0.5% to 54%. Rare but serious complications include compression of the spinal cord or nerve root, infection, cement embolization causing pulmonary infarct and clinical symptoms, paradoxical embolization of the cerebral artery, and severe hematomas.


CONCLUSIONS
Vertebroplasty is a safe and effective treatment for vertebral fractures that cannot be treated using conservative measures.
Banerjee
Susitna
S
Faculty of Medicine at the University of Ottawa in Ontario. sbane059@uottawa.ca
Baerlocher
Mark Otto
MO
Asch
Murray R
MR
D001416:Back Pain / Q000175:diagnosis / Q000628:therapy*; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D008159:Lumbar Vertebrae / Q000187:drug effects*; D008297:Male; D010147:Pain Measurement; D010148:Intractable Pain / Q000175:diagnosis / Q000628:therapy*; D018579:Patient Selection; D019904:Polymethyl Methacrylate / Q000494:pharmacology* / Q000627:therapeutic use; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D001843:Bone Cements; D019904:Polymethyl Methacrylate