Chiras J, Depriester C, Weill A, Sola-Martinez M T, Deramond H
Service de Neuroradiologie Charcot, Hôpital de La Salpêtrière, Paris.
J Neuroradiol. 1997 Jun;24(1):45-59.
Percutaneous vertebroplasty is a technique of interventional radiology, which allows to fulfill pathologic vertebral body with acrylic cement. This method is used to strengthen the vertebral body and reduce pain in some diseases involving the vertebra. Main indications are spine angiomas, metastases and osteoporosis. The vertebroplasty is realised under neuroleptanalgesia for cervical spine antero lateral way is used. For thoracic or lumbar vertebra, the way of approach is usually transpedicular; but in some cases, this approach is not possible: osteolysis of the pedicle, surgical osteosynthesis; in such cases, a postero lateral approach is realized. Technical incidents are not rare, but are usually asymptomatic. More frequent are venous filling with cement; the veins involved can be intra spinal (vertebral plexus) or paraspinal. Instead of this frequency pulmonary embolism in direct relation with the vertebroplasty where not reported. Extravasation in intervertebral disk or soft tissue can also be observed. This last incident can be in relation with the way of the needle or with a cortical rupture. Local complications are rare: rate of neurological deficit or infection is under 0.5%. Radicular pain is observed in 3.7% of cases. These complications are in close relation with the radiological involvement of the vertebra: cortical disruption, heterogeneous Lysis of the vertebral body. The frequency of complications is 1.3% in osteoporosis, 2.5% in spine angiomas and 10% in metastatic disease. Indications concern lesion involving the vertebral body: symptomatic spine angiomas; painful osteoporotic fractures after medical treatment or in patients with a high risk of decubitus complications; in metastatic disease, vertebroplasty is a way to consolidate the vertebral body and release pain. It can be usefull in recurrent pain after chemotherapy and/or radiotherapy, and also in unstable vertebra to obtain a stabilization before radiotherapic or chemotherapic treatment isolated or in combination with surgical osteosynthesis.
经皮椎体成形术是一种介入放射学技术，它通过向病变的椎体注入丙烯酸骨水泥来实现治疗目的。该方法用于强化椎体并减轻某些累及椎体疾病的疼痛。主要适应证包括脊柱血管瘤、转移瘤和骨质疏松症。椎体成形术在神经安定镇痛下实施，颈椎采用前外侧入路。对于胸椎或腰椎，通常采用经椎弓根入路；但在某些情况下，这种入路不可行，如椎弓根骨质溶解、外科骨固定术；此时，则采用后外侧入路。技术并发症并不罕见，但通常无症状。更常见的是骨水泥静脉内充盈，受累静脉可为椎管内（椎静脉丛）或椎旁静脉。与此发生率相反，与椎体成形术直接相关的肺栓塞未见报道。也可观察到骨水泥椎间盘或软组织外渗。这一并发症可能与穿刺针的进针路径或皮质破裂有关。局部并发症罕见：神经功能缺损或感染发生率低于0.5%。神经根性疼痛在3.7%的病例中可见。这些并发症与椎体的放射学改变密切相关：皮质破坏、椎体不均匀溶解。并发症发生率在骨质疏松症中为1.3%，脊柱血管瘤中为2.5%，转移性疾病中为10%。适应证涉及椎体病变：有症状的脊柱血管瘤；药物治疗后疼痛性骨质疏松性骨折或有发生褥疮并发症高风险的患者；在转移性疾病中，椎体成形术是强化椎体和缓解疼痛的一种方法。它可用于化疗和/或放疗后复发疼痛的患者，也可用于不稳定椎体，以便在单独或联合外科骨固定术的放疗或化疗前实现稳定。
