Percutaneous vertebroplasty is a procedure that involves injecting polymethyl
methacrylate (PMMA) into a compressed vertebral body to provide stabilization of
microfractures and possibly regain some of the lost vertebral body height. An
attempt is made to fill the entire front 50 – 60% of the vertebral body. This
ensures that the procedure will be sufficient to stabilize and strengthen the
body. The PMMA is injected under live fluoroscopy. Barium is mixed with the PMMA
to make visualization of the cement possible. Careful injections minimizes the
most common significant complications that involve cement extruding out through
the back wall of the body either in existing veins or through a fracture in the
posterior wall. The patient remains in the prone position for some 20 minutes to
allow the PMMA to harden. The patient is then turned to the supine position and
allowed to rest for another 40 minutes before being allowed to sit and then
stand.
This procedure typically will relieve some pain in a symptomatic but chronic
fracture. It can relieve 70% or more of the pain in a symptomatic acute
compression fracture. Careful physical exam, an MRI or CT scan and appropriate
lab studies such as CBC and coagulation studies are necessary prerequisites to a
safe and effective vertebroplasty procedure.