Answer
Answer
Inclusion criteria include the following: pain localized to a fracture or tumor, pain refractory to medical management, or a fracture less than 12 months old.
Exclusion criteria include the following: fracture extending to posterior vertebral cortex retropulsed fragment, cord compression, radiculopathy, fever and/or sepsis, or coagulopathy.
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Media Gallery
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Anterior wedge compression fracture with intact posterior vertebral cortex.
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Transpedicular placement of a trocar in the anterior third of the fractured vertebral body.
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Anterior wedge compression fracture after fusion of the fracture fragments with methylmethacrylate.
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Lateral radiograph of fractured vertebra shows the initial placement of the trocar.
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Injection of methylmethacrylate through the trocar in anterior one third of the vertebral body.
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Compression fracture after vertebroplasty.
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In a vertebral hemangioma, the fine trabeculae are replaced by venous channels, which predispose the patient to painful microfractures.
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In a vertebral hemangioma after vertebroplasty, the venous channels are now filled with acrylic.
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Two adjacent vertebral hemangiomas causing continuous back pain as seen by MRI (A) and CT (B, C, D). Fluoroscopic appearance prevertebroplasty (E, F) and postvertebroplasty (G, H). The patient's pain had abated by the end of the procedure.
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A vertebral burst fracture is a fracture that cannot be treated safely by using vertebroplasty.
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Once an anterior wedge compression fracture has occurred, the physics of load bearing distribution are altered, creating abnormal stress points on the adjacent vertebra that can lead to a second fracture. This, however, is not the result of the vertebroplasty procedure; rather, it is a consequence of the wedge deformity of the original fracture exerting additional stresses on the adjacent weakened osteoporotic vertebra. A second fracture is likely to occur from this deformity, regardless of whether a vertebroplasty procedure is performed on the first fracture. Some authorities believe vertebroplasty stops the progression of a compression fracture, preventing further wedge deformity and likely reducing the chance of a second fracture.
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In kyphoplasty, a KyphX inflatable bone tamp is percutaneously advanced into the collapsed vertebral body (A). It is then inflated, (B) elevating the depressed endplate, creating a central cavity, and compacting the remaining trabeculae to the periphery. Once the balloon tamp is deflated and withdrawn, the cavity (C) is filled under low pressure with a viscous preparation of methylmethacrylate (D).
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Reduction in kyphotic angulation after kyphoplasty.
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This image was obtained in an 80-year-old man with a steroid-induced osteoporosis and a painful acute midthoracic vertebral compression fracture. Several additional chronic fractures are also present.
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After inflation of balloon tamp, the depressed superior endplate is elevated, and some height is restored. The cavity is then filled with methylmethacrylate. Pain is reduced, and the patient's posture is improved.
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