Percutaneous Cementoplasty

ABSTRACT

Cementoplasty includes percutaneous procedures like vertebroplasty, kyphoplasty, osteoplasty, and sacroplasty. Bone packing with cement aims to treat or prevent vertebral and extraspinal pathological fractures and relieve pain in patients with osteoporosis and bone metastases. The authors outline the accepted and newer indications for patient selection and present the fundamentals of image-guided lesion access and cement injection. Practitioners should evaluate each patient carefully and have a thorough knowledge of the anatomy, the technique, the expected outcomes, and the potential complications. Detailed informed consent and multidisciplinary decision making are recommended. Understanding of the particular advantages and limitations of the various modern filler materials is also crucial for a successful and uncomplicated procedure. Future developments include new mechanical devices for effective restoration of vertebral height, as well as the introduction of osteoconductive and osteoinductive cements that will be able to promote more physiological bone healing.

KEYWORDS

Osteoporosis - bone metastasis - cementoplasty - vertebroplasty - osteoplasty

REFERENCES

• 1 Peh W C, Munk P L, Rashid F, Gilula L A. Percutaneous vertebral augmentation: vertebroplasty, kyphoplasty and skyphoplasty.  Radiol Clin North Am. 2008;  46 611-635 vii
• 2 Gangi A, Sabharwal T, Irani F G, Buy X, Morales J P, Adam A. Standards of Practice Committee of the Society of Interventional Radiology . Quality assurance guidelines for percutaneous vertebroplasty.  Cardiovasc Intervent Radiol. 2006;  29 173-178
• 3 Gangi A, Guth S, Imbert J P, Marin H, Dietemann J L. Percutaneous vertebroplasty: indications, technique, and results.  Radiographics. 2003;  23 e10
• 4 Gangi A, Wong L, Guth S, Dietermann J. Percutaneous vertebroplasty: indications, technique, and results.  Semin Intervent Radiol. 2002;  19 265-270
• 5 Galibert P, Deramond H, Rosat P, Le Gars D. [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].  Neurochirurgie. 1987;  33 166-168
• 6 Deramond H, Depriester C, Toussaint P, Galibert P. Percutaneous vertebroplasty.  Semin Musculoskelet Radiol. 1997;  1 285-296
• 7 Mathis J M, Barr J D, Belkoff S M, Barr M S, Jensen M E, Deramond H. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures.  AJNR Am J Neuroradiol. 2001;  22 373-381
• 8 Murphy K J, Deramond H. Percutaneous vertebroplasty in benign and malignant disease.  Neuroimaging Clin N Am. 2000;  10 535-545
• 9 McGraw J K, Cardella J, Barr J D SIR Standards of Practice Committee et al. Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty.  J Vasc Interv Radiol. 2003;  14 827-831
• 10 Black D M, Palermo L, Nevitt M C, Genant H K, Christensen L, Cummings S R. The Study of Osteoporotic Fractures Research Group . Defining incident vertebral deformity: a prospective comparison of several approaches.  J Bone Miner Res. 1999;  14 90-101
• 11 Stallmeyer M J, Zoarski G H, Obuchowski A M. Optimizing patient selection in percutaneous vertebroplasty.  J Vasc Interv Radiol. 2003;  14 683-696
• 12 Riggs B L, Melton III L J. The worldwide problem of osteoporosis: insights afforded by epidemiology.  Bone. 1995;  17(5 Suppl) 505S-511S
• 13 Leech J A, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women.  Am Rev Respir Dis. 1990;  141 68-71
• 14 McGraw J K, Lippert J A, Minkus K D, Rami P M, Davis T M, Budzik R F. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up.  J Vasc Interv Radiol. 2002;  13(9 Pt 1) 883-886
• 15 Zapałowicz K, Radek A, Błaszczyk B, Koziński T, Zelechowski J. Percutaneous vertebroplasty with methyl methacrylate bone cement in the treatment of spinal angiomas and neoplasms.  Ortop Traumatol Rehabil. 2003;  5 185-188
• 16 McDonald R J, Trout A T, Gray L A, Dispenzieri A, Thielen K R, Kallmes D F. Vertebroplasty in multiple myeloma: outcomes in a large patient series.  AJNR Am J Neuroradiol. 2008;  29 642-648
• 17 Cotten A, Deprez X, Migaud H, Chabanne B, Duquesnoy B, Chastanet P. Malignant acetabular osteolyses: percutaneous injection of acrylic bone cement.  Radiology. 1995;  197 307-310
• 18 Kelekis A, Lovblad K O, Mehdizade A et al.. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results.  J Vasc Interv Radiol. 2005;  16 81-88
• 19 Hierholzer J, Anselmetti G, Fuchs H, Depriester C, Koch K, Pappert D. Percutaneous osteoplasty as a treatment for painful malignant bone lesions of the pelvis and femur.  J Vasc Interv Radiol. 2003;  14 773-777
• 20 Cotten A, Deramond H, Cortet B et al.. Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas.  AJNR Am J Neuroradiol. 1996;  17 137-142
• 21 Cortet B, Cotten A, Deprez X et al.. [Value of vertebroplasty combined with surgical decompression in the treatment of aggressive spinal angioma. Apropos of 3 cases].  Rev Rhum Ed Fr. 1994;  61 16-22
• 22 Gangi A, Guth S, Imbert J P, Marin H, Wong L. Percutaneous bone tumour management.  Semin Intervent Radiol. 2002;  19 279-286
• 23 Peh W C, Gelbart M S, Gilula L A, Peck D D. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena.  AJR Am J Roentgenol. 2003;  180 1411-1417
• 24 Jang J S, Kim D Y, Lee S H. Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body.  Spine (Phila Pa 1976). 2003;  28 1588-1592
• 25 Rami P M, McGraw J K, Heatwole E V, Boorstein J M. Percutaneous vertebroplasty in the treatment of vertebral body compression fracture secondary to osteogenesis imperfecta.  Skeletal Radiol. 2002;  31 162-165
• 26 Cardon T, Hachulla E, Flipo R M et al.. Percutaneous vertebroplasty with acrylic cement in the treatment of a Langerhans cell vertebral histiocytosis.  Clin Rheumatol. 1994;  13 518-521
• 27 Masala S, Pipitone V, Tomassini M, Massari F, Romagnoli A, Simonetti G. Percutaneous vertebroplasty in painful schmorl nodes.  Cardiovasc Intervent Radiol. 2006;  29 97-101
• 28 Cho D Y, Lee W Y, Sheu P C. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation.  Neurosurgery. 2003;  53 1354-1360 discussion 1360-1361
• 29 Verlaan J J, Dhert W J, Oner F C. Vertebroplasty for burst fractures.  J Neurosurg Spine. 2005;  2 398-399 author reply 399
• 30 Sabharwal T, Katsanos K, Buy X, Gangi A. Image-guided ablation therapy of bone tumors.  Semin Ultrasound CT MR. 2009;  30 78-90
• 31 Zoarski G H, Snow P, Olan W J et al.. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes.  J Vasc Interv Radiol. 2002;  13(2 Pt 1) 139-148
• 32 Laredo J D, Assouline E, Gelbert F, Wybier M, Merland J J, Tubiana J M. Vertebral hemangiomas: fat content as a sign of aggressiveness.  Radiology. 1990;  177 467-472
• 33 Maynard A S, Jensen M E, Schweickert P A, Marx W F, Short J G, Kallmes D F. Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures.  AJNR Am J Neuroradiol. 2000;  21 1807-1812
• 34 Mathis J M, Wong W. Percutaneous vertebroplasty: technical considerations.  J Vasc Interv Radiol. 2003;  14 953-960
• 35 White S M. Anaesthesia for percutaneous vertebroplasty.  Anaesthesia. 2002;  57 1229-1230
• 36 Della Puppa A, Andreula C, Frass M. Assisted sedation: a safe and easy method for pain-free percutaneous vertebroplasty.  Minerva Anestesiol. 2008;  74 57-62
• 37 Heran M K, Legiehn G M, Munk P L. Current concepts and techniques in percutaneous vertebroplasty.  Orthop Clin North Am. 2006;  37 409-434, vii
• 38 Gangi A, Kastler B A, Dietemann J L. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy.  AJNR Am J Neuroradiol. 1994;  15 83-86
• 39 Caudana R, Renzi Brivio L, Ventura L, Aitini E, Rozzanigo U, Barai G. CT-guided percutaneous vertebroplasty: personal experience in the treatment of osteoporotic fractures and dorsolumbar metastases.  Radiol Med (Torino). 2008;  113 114-133
• 40 Vogl T J, Proschek D, Schwarz W, Mack M, Hochmuth K. CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures.  Eur Radiol. 2006;  16 797-803
• 41 Appel N B, Gilula L A. “Bull's-eye” modification for transpedicular biopsy and vertebroplasty.  AJR Am J Roentgenol. 2001;  177 1387-1389
• 42 Tong F C, Cloft H J, Joseph G J, Rodts G R, Dion J E. Transoral approach to cervical vertebroplasty for multiple myeloma.  AJR Am J Roentgenol. 2000;  175 1322-1324
• 43 Sachs D C, Inamasu J, Mendel E E, Guiot B H. Transoral vertebroplasty for renal cell metastasis involving the axis: case report.  Spine (Phila Pa 1976). 2006;  31 E925-E928
• 44 Mehdizade A, Payer M, Somon T et al.. Percutaneous vertebroplasty through a transdiscal access route after lumbar transpedicular instrumentation.  Spine J. 2004;  4 475-479
• 45 Evans A J, Jensen M E, Kip K E et al.. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases.  Radiology. 2003;  226 366-372
• 46 Kim A K, Jensen M E, Dion J E, Schweickert P A, Kaufmann T J, Kallmes D F. Unilateral transpedicular percutaneous vertebroplasty: initial experience.  Radiology. 2002;  222 737-741
• 47 Minart D, Vallée J N, Cormier E, Chiras J. Percutaneous coaxial transpedicular biopsy of vertebral body lesions during vertebroplasty.  Neuroradiology. 2001;  43 409-412
• 48 McGraw J K, Heatwole E V, Strnad B T, Silber J S, Patzilk S B, Boorstein J M. Predictive value of intraosseous venography before percutaneous vertebroplasty.  J Vasc Interv Radiol. 2002;  13(2 Pt 1) 149-153
• 49 Vasconcelos C, Gailloud P, Beauchamp N J, Heck D V, Murphy K J. Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutive procedures.  AJNR Am J Neuroradiol. 2002;  23 913-917
• 50 Munk P L, Rashid F, Heran M K et al.. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone.  J Vasc Interv Radiol. 2009;  20 903-911
• 51 Molloy S, Riley III L H, Belkoff S M. Effect of cement volume and placement on mechanical-property restoration resulting from vertebroplasty.  AJNR Am J Neuroradiol. 2005;  26 401-404
• 52 Belkoff S M, Mathis J M, Jasper L E, Deramond H. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior.  Spine (Phila Pa 1976). 2001;  26 1537-1541
• 53 Heini P F, Berlemann U. Bone substitutes in vertebroplasty.  Eur Spine J. 2001;  10(Suppl 2) S205-S213
• 54 Lieberman I H, Togawa D, Kayanja M M. Vertebroplasty and kyphoplasty: filler materials.  Spine J. 2005;  5(6 Suppl) 305S-316S
• 55 Deramond H, Wright N T, Belkoff S M. Temperature elevation caused by bone cement polymerization during vertebroplasty.  Bone. 1999;  25(2 Suppl) 17S-21S
• 56 Pomrink G J, DiCicco M P, Clineff T D, Erbe E M. Evaluation of the reaction kinetics of CORTOSS, a thermoset cortical bone void filler.  Biomaterials. 2003;  24 1023-1031
• 57 Erbe E M, Clineff T D, Gualtieri G. Comparison of a new bisphenol-a-glycidyl dimethacrylate-based cortical bone void filler with polymethyl methacrylate.  Eur Spine J. 2001;  10(Suppl 2) S147-S152
• 58 Bohner M. Physical and chemical aspects of calcium phosphates used in spinal surgery.  Eur Spine J. 2001;  10(Suppl 2) S114-S121
• 59 Hitchon P W, Goel V, Drake J et al.. Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model.  J Neurosurg. 2001;  95(2 Suppl) 215-220
• 60 Nussbaum D A, Gailloud P, Murphy K. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site.  J Vasc Interv Radiol. 2004;  15 1185-1192
• 61 Yeom J S, Kim W J, Choy W S, Lee C K, Chang B S, Kang J W. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures.  J Bone Joint Surg Br. 2003;  85 83-89
• 62 Padovani B, Kasriel O, Brunner P, Peretti-Viton P. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty.  AJNR Am J Neuroradiol. 1999;  20 375-377
• 63 François K, Taeymans Y, Poffyn B, Van Nooten G. Successful management of a large pulmonary cement embolus after percutaneous vertebroplasty: a case report.  Spine (Phila Pa 1976). 2003;  28 E424-E425
• 64 Choe D H, Marom E M, Ahrar K, Truong M T, Madewell J E. Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty.  AJR Am J Roentgenol. 2004;  183 1097-1102
• 65 Scroop R, Eskridge J, Britz G W. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report.  AJNR Am J Neuroradiol. 2002;  23 868-870
• 66 Lin E P, Ekholm S, Hiwatashi A, Westesson P L. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.  AJNR Am J Neuroradiol. 2004;  25 175-180
• 67 Alfonso Olmos M, Silva González A, Duart Clemente J, Villas Tomé C. Infected vertebroplasty due to uncommon bacteria solved surgically: a rare and threatening life complication of a common procedure: report of a case and a review of the literature.  Spine (Phila Pa 1976). 2006;  31 E770-E773
• 68 Vasconcelos C, Gailloud P, Martin J B, Murphy K J. Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty.  J Vasc Interv Radiol. 2001;  12 1001-1002
• 69 Cloft H J, Easton D N, Jensen M E, Kallmes D F, Dion J E. Exposure of medical personnel to methylmethacrylate vapor during percutaneous vertebroplasty.  AJNR Am J Neuroradiol. 1999;  20 352-353
• 70 Peh W C, Gilula L A, Peck D D. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures.  Radiology. 2002;  223 121-126
• 71 Cotten A, Boutry N, Cortet B et al.. Percutaneous vertebroplasty: state of the art.  Radiographics. 1998;  18 311-320 discussion 320-323
• 72 Kallmes D F, Comstock B A, Heagerty P J et al.. A randomized trial of vertebroplasty for osteoporotic spinal fractures.  N Engl J Med. 2009;  361 569-579
• 73 Buchbinder R, Osborne R H, Ebeling P R et al.. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.  N Engl J Med. 2009;  361 557-568
• 74 Noonan P. Randomized vertebroplasty trials: bad news or sham news?.  AJNR Am J Neuroradiol. 2009;  30 1808-1809
• 75 Baerlocher M O, Munk P L, Radvany M G, Murphy T P, Murphy K J. Vertebroplasty, research design, and critical analysis.  J Vasc Interv Radiol. 2009;  20 1277-1278
• 76 Munk P L, Liu D M, Murphy K P, Baerlocher M O. Effectiveness of vertebroplasty: a recent controversy.  Can Assoc Radiol J. 2009;  60 170-171
• 77 Brown D B, Gilula L A, Sehgal M, Shimony J S. Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty.  AJR Am J Roentgenol. 2004;  182 319-322
• 78 Voormolen M H, Lohle P N, Juttmann J R, van der Graaf Y, Fransen H, Lampmann L E. The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty.  J Vasc Interv Radiol. 2006;  17 71-76
• 79 Lin W C, Lee Y C, Lee C H et al.. Refractures in cemented vertebrae after percutaneous vertebroplasty: a retrospective analysis.  Eur Spine J. 2008;  17 592-599
• 80 Trout A T, Kallmes D F. Does vertebroplasty cause incident vertebral fractures? A review of available data.  AJNR Am J Neuroradiol. 2006;  27 1397-1403
• 81 Lieberman I H, Dudeney S, Reinhardt M K, Bell G. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures.  Spine (Phila Pa 1976). 2001;  26 1631-1638
• 82 Phillips F M, Ho E, Campbell-Hupp M et al.. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures.  Spine (Phila Pa 1976). 2003;  28 2260-2265
• 83 Rao R D, Singrakhia M D. Painful osteoporotic vertebral fracture. Pathogenesis, evaluation, and roles of vertebroplasty and kyphoplasty in its management.  J Bone Joint Surg Am. 2003;  85-A 2010-2022
• 84 Mathis J M, Ortiz A O, Zoarski G H. Vertebroplasty versus kyphoplasty: a comparison and contrast.  AJNR Am J Neuroradiol. 2004;  25 840-845
• 85 Voormolen M H, Mali W P, Lohle P N et al.. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study.  AJNR Am J Neuroradiol. 2007;  28 555-560
• 86 McGirt M J, Parker S L, Wolinsky J P, Witham T F, Bydon A, Gokaslan Z L. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature.  Spine J. 2009;  9 501-508
• 87 Wardlaw D, Cummings S R, Van Meirhaeghe J et al.. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial.  Lancet. 2009;  373 1016-1024
• 88 Gill J B, Kuper M, Chin P C, Zhang Y, Schutt Jr R. Comparing pain reduction following kyphoplasty and vertebroplasty for osteoporotic vertebral compression fractures.  Pain Physician. 2007;  10 583-590
• 89 Taylor R S, Taylor R J, Fritzell P. Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety.  Spine (Phila Pa 1976). 2006;  31 2747-2755
• 90 Liu J T, Liao W J, Tan W C et al.. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study.  Osteoporos Int. 2010;  21 359-364
• 91 Eck J C, Nachtigall D, Humphreys S C, Hodges S D. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature.  Spine J. 2008;  8 488-497
• 92 Cloft H J, Jensen M E. Kyphoplasty: an assessment of a new technology.  AJNR Am J Neuroradiol. 2007;  28 200-203
• 93 Hulme P A, Krebs J, Ferguson S J, Berlemann U. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies.  Spine (Phila Pa 1976). 2006;  31 1983-2001
• 94 Whitlow C T, Mussat-Whitlow B J, Mattern C W, Baker M D, Morris P P. Sacroplasty versus vertebroplasty: comparable clinical outcomes for the treatment of fracture-related pain.  AJNR Am J Neuroradiol. 2007;  28 1266-1270