title: Thick cement usage in percutaneous vertebroplasty for malignant vertebral fractures at high risk for cement leakage.
abstract: OBJECTIVE
  To assess the feasibility and safety of transpedicular percutaneous vertebroplasty (PVP) using thick bone cement in patients with intractable metastatic vertebral pain and at high risk for cement leakage.
  
  
  METHODS
  Unilateral transpedicular PVP using firm bone cement was performed in 77 patients with intractable pain due to vertebral metastases in the thoracolumbar spine, who had one or more relative contraindication to PVP. Primary outcome measures were the severity of pain as assessed on a 100-mm visual analogue scale and daily morphine consumption. Secondary outcome measures were the degree of disability and the incidence of procedure-related adverse outcomes. The outcome measures were assessed at the preoperative visit and at 1 day, 1 week, 4 weeks and 12 weeks after the procedure.
  
  
  RESULTS
  Sixty-three (81.8%) patients completed the 12-week follow-up period. There were 30 men and 33 women, with a mean age of 58±11 (SD) [range: 34-81 years]. Compared with pre-procedure value, all post-procedure pain scores were significantly lower (P<0.0001). Likewise, there was a statistically significant reduction in daily morphine consumption at all follow-up times (P<0.0001). The ambulation score, ADL, and ODI were all significantly lower at all assessment times compared with pre-procedure values (P<0.0001). No serious adverse effects were observed.
  
  
  CONCLUSIONS
  PVP using thick bone cement could be administered with reasonable safety to patients suffering from intractable pain caused by vertebral metastases who were at high risk for cement leakage. The procedure was associated with significant improvement of pain and disability.
authors.affiliation: Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: R M
authors.initials: RM
authors.lastname: Reyad
authors.affiliation: Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: H Z
authors.initials: HZ
authors.lastname: Ghobrial
authors.affiliation: Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: S M
authors.initials: SM
authors.lastname: Hakim
authors.affiliation: Departments of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: R H
authors.initials: RH
authors.lastname: Hashem
authors.affiliation: Departments of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: Elsaman
authors.affiliation: Departments of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: mohamedhamed24672@yahoo.com.
authors.forename: M H
authors.initials: MH
authors.lastname: Shaaban
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty
chemical_list: D001843:Bone Cements
keywords: Bone cement; Cement leakage; Interventional radiology; Pain relief; Percutaneous vertebroplasty