Percutaneous vertbroplasty was first performed by Deramond in 1984 at the Amiens Centre Hospitalier Universitaire in France. It consists in the injection of acrylic cement in the vertebral body to reinforce it. The first indication was an aggressive angioma. Indications have been extended to metastatic vertebral state and to hyperalgic osteoporotic fractures. The evolution of material and experience of operators allowed for an expansion of the use to traumatic fractures and metastatic vertebrae reaching corticals, in particular posterior. The objective of this internet page is to present consolidation techniques allowing treatment of patients previously unable to be treated by vertebroplasty. Diverse techniques are necessary to increase the safety of the procedure, learning and control of simple vertebroplasties are compulsory before performing more advanced procedures.
Our university center has performed since 2001 ,more thatn 5000 vertebraoplasties of all indications.
The first prescriber were the oncology services in the frame of metastatic hyperalgic vertebral lesions. The first cases were patients escaping from all therapeutic on an analgesic, functional or oncologic point of view. In view of the very satisfactory results of our series and the coherence with the literature data, the prescribing oncologic physicians positioned vertebroplasty on the forefront of the therapeutic arsenal in association with the classical therapies. The evolution of the techniques and the acquisition of experience have expanded the indications for patients which couldn’t be treated with extreme damage to the vertebral body and the posterior axis, and numerous patients could benefit from a vertebral consolidation significantly enhancing their quality of life. Looking at the low complication rate even in the most difficult cases, the benefit/risk ratio is considered very good by the prescribers.
In the same manner, the rheumatology physicians took care of their patients for hyperalgic vertebral fractures after waiting several months the failure of a conservative heavy treatment including prolonged bed rest, use of a corset uncomfortable for the patients, and antalgic treatment up to class 3 of the oms (morphinics in particular). This late address put us in front of extreme cases of vertebral fractures going to the vertebraplana. The experience and the acquired technique, the vertebroplasty realization in these extreme cases brought a real enhancement for the patient immediately after the operation. Thus the rheumatologists faced patients very demanding not understanding why they waited so long to perform this rapid, painless procedure under local anesthesia and immediately efficient. The number of days without pain loss was not well perceived by the patients, therefore the rheumatologists have progressively offered a vertebral consolidation in shorter delays. In view of the satisfactory results and the sustainable clinical enhancement and the satisfaction of the patients, the vertebroplasty has imposed itself as a forefront and modern therapeutic. The contradictory studies published in the New England Journal have not altered the trust in the technique, these studies showing more than anything that when the vertebroplasty is not indicated on common criterions, the results were the same as placebos.
The end of this mini invasive tecnic takes its true meaning when the intervention is associated to an efficient and well tolerated local anesthesia. Avoiding the general anesthesia and its complications. Thus a population of fragile patients until now counter indicated to general anesthesia and to interventions have had access to the micro-invasive procedures: in particular the older patients, and those whose vital prognostic at short and middle term was bad, and for those whose ratio benefit/risk of the invasive intervention is low. Thus interventional spinal radiology associated to the advantages of the local anesthesia allowed to widen the action to patients who didn’t have access until now to conventional surgery under general anesthesia. These supplementary arguments motivate the physicians facing this type of pathology to offer a vertebroplasty to their most fragile patients.