Osteoporotic vertebral body fracture

The procedure is completed when the osteolytic lesion within the vertebral body is completely or partially filled (Fig. 38.5a-0 or when the anterior two thirds of the fractured, osteoporotic vertebral body is filled and/ or the cement is homogenously distributed between both endplates. It has to be taken into account that the cavity of the needle contains an additional 1-2 cc of cement. While the stylet of the needle is pushed forward, this cement is also injected into the vertebral body. This should be done under fluoroscopic control to avoid... 

Jensen ME, Evans AJ, Mathis JM et al (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures technical aspects. AJNR Am J Neuroradiol 18 1897-1904... 

Bone tissue is constantly being renewed by the concerted action of osteoblasts and osteoclasts. Bone remodeling has two main phases a resorption phase consisting in the removal of old bone by osteoclasts, and a later phase of new bone formation driven by osteoblasts [6], Thus, the activity of osteoblasts and osteoclasts determines bone mass, bone geometry, bone quality, and, subsequently, bone strength [7, 8]. Osteoporosis is a prevalent disorder consisting in decreased bone mass and/or abnormal bone microarchitecture that impairs bone strength and increases the risk of fracture. Therefore, patients with osteoporosis may suffer fractures as a result of minor trauma, or even in the absence of trauma. The most common osteoporotic fractures are those of the vertebral bodies, the hip, the wrist, the shoulder, and the pelvis. 

Osteoporosis is a condition of low bone mass and microarchitectural disruption that results in fractures with minimal trauma. Characteristic sites of fracture include vertebral bodies, the distal radius, and the proximal femur, but osteoporotic individuals have generalized skeletal fragility, and fractures at sites such as ribs and long bones also occur. Fracture risk increases exponentially with age, related both to decreased bone density and to factors such as decreased muscle strength and increased risk of falls. 

Observational studies Administration of the optimal dose of alfentanil for percutaneous vertebroplasty has been investigated in 50 patients with osteoporotic vertebral fractures [60 ]. The median effective dose was 1.05 mg/hour when the infusion was begun 30 minutes before the procedure, equating to 0.27 micrograms/kg/minute for a median body weight of 65 kg. Adverse reactions included transient apnea in two patients and nausea and/or vomiting in three. Patients overall satisfaction with the procedure was 89%. 

Fig. 38.2a-d. A 59-year-old female with an osteoporotic fracture of the 1st lumbar vertebra. Image series (a-d) demonstrates safe needle positioning in the anterior third of the altered vertebral body... 

Fig.38.6a-d. A 58-year-old female patient with a treatment-refractory painful osteoporotic fracture of the rMumbar vertebra. Sagittal (a) and coronal (b) images prior to PV illustrate the impression fracture of the cranial endplate and a height reduction in the center of the vertebral body of about 20%. After PV, sagittal (c) and coronal (d) images show sufficient cement filling of the vertebral body with a column between the endplates... 

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