Aim: To describe technique, indications and results of percutaneous vertebroplasty (PV). Method: PV is accomplished by injecting cement into a vertebral body via a percutaneously placed cannula under imaging guidance. Results: In patients with osteoporotic compression fractures the treatment has to be done as early as a few weeks after the acute onset of the pain that requires parenteral narcotics. Late treatment can be successful in relieving pain particularly in patients with osteonecrosis on the site of the vertebral collapse.

PV is also indicated in patients complaining with severe back pain related to metastatic lesions or myeloma involving vertebral bodies if the lesion is not associated with neurological signs or epidural involvement. PV can be performed before radiation therapy or reserved for patients who have already received maximal dose radiation. PV induced complications are more frequent in these indications and that treatment should be considered after a multidisciplinary discussion.

PV is the treatment of choice in painful and or aggressive vertebral hemangiomas. Association with injection of absolute ethanol is suggested in aggressive forms of that pathology. Conclusion: PV is a standard of care for the treatment of pain resulting from spinal compression fractures and vertebral Hemangiomas.

Aim: To show the place of percutaneous vertebroplasty (PV) in the treatment of painful osteoporotic vertebral compression fractures (VCF). VCF is a common and often debilitating complication of osteoporosis. Although most fractures heal within a few weeks or months, a minority of patients continues to suffer with pain that does not respond to conservative therapy. Methods: PV is accomplished by percutaneous injection of cement into the fractured vertebral body. Reinforcing and stabilizing the fracture provides pain relief. Injection of cement is accomplished under real time using a bilateral transpedicular approach or a unilateral transpedicular or parapedicular route. Results: PV is indicated in patients with severe, persistent and often incapacitating focal back pain not responding to a standard medical therapy of 4 to 12 weeks duration and related to one or more collapsed vertebral bodies. PV should be used earlier in patients at risk of immobilization complications and requiring narcotics. The success rate exceeds 90% and the complication rate is lower than 1%. Most of the complications are transient and should be avoided using good technique. Conclusion: PV should be always considered as a good alternative treatment compared to medical therapy in painful patients with osteoporotic compression fractures.

Aims: To assess prospectively the effectiveness and safety of Cortossª, a new synthetic, biocompatible, highly radiopaque composite in the percutaneous augmentation of vertebral compression fractures. Methods: Patients with severe pain (> 50mm VAS) associated to radiographic evidence of osteoporotic or malignant vertebral compression fracture(s). Cortoss was injected with the help of a syringe-catheter system introduced into a 10 to 11-gauge needle under continuous ßuoroscopic control. All leakages and adverse events were to be reported. Assessments were made before vertebroplasty (bv) and after 3 days (3d), 1 week (1w), 1 month (1m), 3 (3m) and 6 months (6m). Results: Fifty-eight interventions were performed in 53 patients. Mean pain scores (mm VAS) decreased from 69 (bv) to 39 (3d), 39 (1w), 31 (1m), 23 (3m), 26 (6m). A mean (range) of 4.3 (1.5–8) mL of Cortoss was injected per vertebral body. Augmented vertebral bodies remained stable over time. Leakage of Cortoss occurred in 76% of interventions. No pulmonary emboli or persistent nerve root or medullary irritation occurred in association to leakage of Cortoss. One patient required local corticosteroid injection for pain associated to soft tissue leakage. The visibility of Cortoss on all imaging techniques was excellent and its use generally considered to be easy. Conclusions: The use of Cortoss for augmentation of vertebral compression fractures appears to be safe and effective and represents a promising biocompatible alternative to PMMA thanks to its radiopacity and ease of use.