PERCUTANEOUS VERTEBROPLASTY AND KYPHOPLASTY IN THE TREATMENT OF VERTEBRAL ALGODYSTROPHY: A PROSPECTIVE STUDY

Abstract

Introduction: Currently, percutaneous vertebroplasty and kyphoplasty are commonly used for the treatment of vertebral osteoporotic compression fractures (Phillips et al., 2003). Even without fractures, an osteoporotic vertebral body may develop some structural modifications with dystrophic features, defined as “intravertebral clefts” and “intravertebral vacuum” (Missori et al, 2005). These conditions may be painful and the MRI is the imaging technique of choice for their evaluation.

Materials and methods: A prospective consecutive series of 21 elderly patients with pain in the thoracolumbar or lumbar spine were evaluated. MRI findings showed modifications of the vertebral body consistent with algodystrophy. Lesions were treated by means of percutaneous augmentation with PMAA, using a single pedicle approach. The outcomes of such procedure were evaluated with a visual analogue scale for pain (Chen et al, 2005).

Results and conclusions: Percutaneous augmentation has not determined any complications neither early nor late. Outcomes have showed to be good or excellent, except for a patient with insufficient amount of injected PMMA. Augmentation of the vertebral body showed to be effective in reducing or solving pain, in spite of the biomechanical alterations due to algodystrophic phenomena. During kyphoplasty, particularly when performed for painful Schmorl nodes, balloon inflation creates a positive pressure room inside the vertebral body opposed to the negative pressure caused by abnormality of the discovertebral junction. This phenomenon makes it possible to fill the vacuum with PMMA without the risk of cement leakage.