Percutaneous vertebroplasty , results and technical problems with the use of a Cost effective Technique

Abstract

Osteoporotic vertebral compression fractures are a common problem in elderly. Although most of them heal by conservative management, some may lead to severe pain and disability. Percutaneous vertebroplasty has been effective in relieving pain in these patients with very few complications. However, the present vertebroplasty kits marketed are expensive and are a burden to our society. Hence we deviced a new technique with the help of jamshedi needle, regular bone cement(Depuy) used in routine arthroplasty and barium sulfate. Our aim of the study was to understand the technical problems associated with the use of this technique and to know whether we can safely inject sufficient amount of cement into vertebral body so as patient gets good immediate pain relief. The main concern with this technique was early setting time of cement, thus reducing the available working time and poor visibility. We treated 32 patients with 47 level vertebroplasties. Mean VAS was reduced from 8.65 to 3.23, 30 patients were mobilized on the same or next day and remain pain free at the end of one year. There were cases of cement leak into adjacent disc space, or anteriorly or into canal, but none had any significant impact on outcome. Regarding technical problems, one patient developed transient deficit, in one patient we had to waste one packet of cement, and in one patient visibility was poor. We conclude that our procedure is a safe procedure, and highly cost effective, while with some technical adjustments, one can work within the available time and inject significant cement into vertebral body.