Percutaneous Cementoplasty

 

 Buy Article Permissions and Reprints

ABSTRACT

Cementoplasty includes percutaneous procedures like vertebroplasty, kyphoplasty, osteoplasty, and sacroplasty. Bone packing with cement aims to treat or prevent vertebral and extraspinal pathological fractures and relieve pain in patients with osteoporosis and bone metastases. The authors outline the accepted and newer indications for patient selection and present the fundamentals of image-guided lesion access and cement injection. Practitioners should evaluate each patient carefully and have a thorough knowledge of the anatomy, the technique, the expected outcomes, and the potential complications. Detailed informed consent and multidisciplinary decision making are recommended. Understanding of the particular advantages and limitations of the various modern filler materials is also crucial for a successful and uncomplicated procedure. Future developments include new mechanical devices for effective restoration of vertebral height, as well as the introduction of osteoconductive and osteoinductive cements that will be able to promote more physiological bone healing.

REFERENCES

• 1 Peh W C, Munk P L, Rashid F, Gilula L A. Percutaneous vertebral augmentation: vertebroplasty, kyphoplasty and skyphoplasty.  Radiol Clin North Am. 2008;  46 611-635 vii
  CrossrefPubMedGoogle Scholar
• 2 Gangi A, Sabharwal T, Irani F G, Buy X, Morales J P, Adam A. Standards of Practice Committee of the Society of Interventional Radiology . Quality assurance guidelines for percutaneous vertebroplasty.  Cardiovasc Intervent Radiol. 2006;  29 173-178
  CrossrefPubMedGoogle Scholar
• 3 Gangi A, Guth S, Imbert J P, Marin H, Dietemann J L. Percutaneous vertebroplasty: indications, technique, and results.  Radiographics. 2003;  23 e10
  CrossrefPubMedGoogle Scholar
• 4 Gangi A, Wong L, Guth S, Dietermann J. Percutaneous vertebroplasty: indications, technique, and results.  Semin Intervent Radiol. 2002;  19 265-270
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Galibert P, Deramond H, Rosat P, Le Gars D. [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].  Neurochirurgie. 1987;  33 166-168
  PubMedGoogle Scholar
• 6 Deramond H, Depriester C, Toussaint P, Galibert P. Percutaneous vertebroplasty.  Semin Musculoskelet Radiol. 1997;  1 285-296
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Mathis J M, Barr J D, Belkoff S M, Barr M S, Jensen M E, Deramond H. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures.  AJNR Am J Neuroradiol. 2001;  22 373-381
  PubMedGoogle Scholar
• 8 Murphy K J, Deramond H. Percutaneous vertebroplasty in benign and malignant disease.  Neuroimaging Clin N Am. 2000;  10 535-545
  PubMedGoogle Scholar
• 9 McGraw J K, Cardella J, Barr J D SIR Standards of Practice Committee et al. Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty.  J Vasc Interv Radiol. 2003;  14 827-831
  CrossrefPubMedGoogle Scholar
• 10 Black D M, Palermo L, Nevitt M C, Genant H K, Christensen L, Cummings S R. The Study of Osteoporotic Fractures Research Group . Defining incident vertebral deformity: a prospective comparison of several approaches.  J Bone Miner Res. 1999;  14 90-101
  CrossrefPubMedGoogle Scholar
• 11 Stallmeyer M J, Zoarski G H, Obuchowski A M. Optimizing patient selection in percutaneous vertebroplasty.  J Vasc Interv Radiol. 2003;  14 683-696
  PubMedGoogle Scholar
• 12 Riggs B L, Melton III L J. The worldwide problem of osteoporosis: insights afforded by epidemiology.  Bone. 1995;  17(5 Suppl) 505S-511S
  CrossrefPubMedGoogle Scholar
• 13 Leech J A, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women.  Am Rev Respir Dis. 1990;  141 68-71
  CrossrefPubMedGoogle Scholar
• 14 McGraw J K, Lippert J A, Minkus K D, Rami P M, Davis T M, Budzik R F. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up.  J Vasc Interv Radiol. 2002;  13(9 Pt 1) 883-886
  CrossrefPubMedGoogle Scholar
• 15 Zapałowicz K, Radek A, Błaszczyk B, Koziński T, Zelechowski J. Percutaneous vertebroplasty with methyl methacrylate bone cement in the treatment of spinal angiomas and neoplasms.  Ortop Traumatol Rehabil. 2003;  5 185-188
  PubMedGoogle Scholar
• 16 McDonald R J, Trout A T, Gray L A, Dispenzieri A, Thielen K R, Kallmes D F. Vertebroplasty in multiple myeloma: outcomes in a large patient series.  AJNR Am J Neuroradiol. 2008;  29 642-648
  CrossrefPubMedGoogle Scholar
• 17 Cotten A, Deprez X, Migaud H, Chabanne B, Duquesnoy B, Chastanet P. Malignant acetabular osteolyses: percutaneous injection of acrylic bone cement.  Radiology. 1995;  197 307-310
  CrossrefPubMedGoogle Scholar
• 18 Kelekis A, Lovblad K O, Mehdizade A et al.. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results.  J Vasc Interv Radiol. 2005;  16 81-88
  CrossrefPubMedGoogle Scholar
• 19 Hierholzer J, Anselmetti G, Fuchs H, Depriester C, Koch K, Pappert D. Percutaneous osteoplasty as a treatment for painful malignant bone lesions of the pelvis and femur.  J Vasc Interv Radiol. 2003;  14 773-777
  CrossrefPubMedGoogle Scholar
• 20 Cotten A, Deramond H, Cortet B et al.. Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas.  AJNR Am J Neuroradiol. 1996;  17 137-142
  PubMedGoogle Scholar
• 21 Cortet B, Cotten A, Deprez X et al.. [Value of vertebroplasty combined with surgical decompression in the treatment of aggressive spinal angioma. Apropos of 3 cases].  Rev Rhum Ed Fr. 1994;  61 16-22
  PubMedGoogle Scholar
• 22 Gangi A, Guth S, Imbert J P, Marin H, Wong L. Percutaneous bone tumour management.  Semin Intervent Radiol. 2002;  19 279-286
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Peh W C, Gelbart M S, Gilula L A, Peck D D. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena.  AJR Am J Roentgenol. 2003;  180 1411-1417
  PubMedGoogle Scholar
• 24 Jang J S, Kim D Y, Lee S H. Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body.  Spine (Phila Pa 1976). 2003;  28 1588-1592
  CrossrefPubMedGoogle Scholar
• 25 Rami P M, McGraw J K, Heatwole E V, Boorstein J M. Percutaneous vertebroplasty in the treatment of vertebral body compression fracture secondary to osteogenesis imperfecta.  Skeletal Radiol. 2002;  31 162-165
  CrossrefPubMedGoogle Scholar
• 26 Cardon T, Hachulla E, Flipo R M et al.. Percutaneous vertebroplasty with acrylic cement in the treatment of a Langerhans cell vertebral histiocytosis.  Clin Rheumatol. 1994;  13 518-521
  CrossrefPubMedGoogle Scholar
• 27 Masala S, Pipitone V, Tomassini M, Massari F, Romagnoli A, Simonetti G. Percutaneous vertebroplasty in painful schmorl nodes.  Cardiovasc Intervent Radiol. 2006;  29 97-101
  CrossrefPubMedGoogle Scholar
• 28 Cho D Y, Lee W Y, Sheu P C. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation.  Neurosurgery. 2003;  53 1354-1360 discussion 1360-1361
  Google Scholar
• 29 Verlaan J J, Dhert W J, Oner F C. Vertebroplasty for burst fractures.  J Neurosurg Spine. 2005;  2 398-399 author reply 399
  PubMedGoogle Scholar
• 30 Sabharwal T, Katsanos K, Buy X, Gangi A. Image-guided ablation therapy of bone tumors.  Semin Ultrasound CT MR. 2009;  30 78-90
  CrossrefPubMedGoogle Scholar
• 31 Zoarski G H, Snow P, Olan W J et al.. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes.  J Vasc Interv Radiol. 2002;  13(2 Pt 1) 139-148
  CrossrefPubMedGoogle Scholar
• 32 Laredo J D, Assouline E, Gelbert F, Wybier M, Merland J J, Tubiana J M. Vertebral hemangiomas: fat content as a sign of aggressiveness.  Radiology. 1990;  177 467-472
  PubMedGoogle Scholar
• 33 Maynard A S, Jensen M E, Schweickert P A, Marx W F, Short J G, Kallmes D F. Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures.  AJNR Am J Neuroradiol. 2000;  21 1807-1812
  PubMedGoogle Scholar
• 34 Mathis J M, Wong W. Percutaneous vertebroplasty: technical considerations.  J Vasc Interv Radiol. 2003;  14 953-960
  CrossrefPubMedGoogle Scholar
• 35 White S M. Anaesthesia for percutaneous vertebroplasty.  Anaesthesia. 2002;  57 1229-1230
  PubMedGoogle Scholar
• 36 Della Puppa A, Andreula C, Frass M. Assisted sedation: a safe and easy method for pain-free percutaneous vertebroplasty.  Minerva Anestesiol. 2008;  74 57-62
  PubMedGoogle Scholar
• 37 Heran M K, Legiehn G M, Munk P L. Current concepts and techniques in percutaneous vertebroplasty.  Orthop Clin North Am. 2006;  37 409-434, vii
  CrossrefPubMedGoogle Scholar
• 38 Gangi A, Kastler B A, Dietemann J L. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy.  AJNR Am J Neuroradiol. 1994;  15 83-86
  PubMedGoogle Scholar
• 39 Caudana R, Renzi Brivio L, Ventura L, Aitini E, Rozzanigo U, Barai G. CT-guided percutaneous vertebroplasty: personal experience in the treatment of osteoporotic fractures and dorsolumbar metastases.  Radiol Med (Torino). 2008;  113 114-133
  CrossrefPubMedGoogle Scholar
• 40 Vogl T J, Proschek D, Schwarz W, Mack M, Hochmuth K. CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures.  Eur Radiol. 2006;  16 797-803
  CrossrefPubMedGoogle Scholar
• 41 Appel N B, Gilula L A. “Bull's-eye” modification for transpedicular biopsy and vertebroplasty.  AJR Am J Roentgenol. 2001;  177 1387-1389
  PubMedGoogle Scholar
• 42 Tong F C, Cloft H J, Joseph G J, Rodts G R, Dion J E. Transoral approach to cervical vertebroplasty for multiple myeloma.  AJR Am J Roentgenol. 2000;  175 1322-1324
  PubMedGoogle Scholar
• 43 Sachs D C, Inamasu J, Mendel E E, Guiot B H. Transoral vertebroplasty for renal cell metastasis involving the axis: case report.  Spine (Phila Pa 1976). 2006;  31 E925-E928
  CrossrefPubMedGoogle Scholar
• 44 Mehdizade A, Payer M, Somon T et al.. Percutaneous vertebroplasty through a transdiscal access route after lumbar transpedicular instrumentation.  Spine J. 2004;  4 475-479
  CrossrefPubMedGoogle Scholar
• 45 Evans A J, Jensen M E, Kip K E et al.. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases.  Radiology. 2003;  226 366-372
  CrossrefPubMedGoogle Scholar
• 46 Kim A K, Jensen M E, Dion J E, Schweickert P A, Kaufmann T J, Kallmes D F. Unilateral transpedicular percutaneous vertebroplasty: initial experience.  Radiology. 2002;  222 737-741
  CrossrefPubMedGoogle Scholar
• 47 Minart D, Vallée J N, Cormier E, Chiras J. Percutaneous coaxial transpedicular biopsy of vertebral body lesions during vertebroplasty.  Neuroradiology. 2001;  43 409-412
  CrossrefPubMedGoogle Scholar
• 48 McGraw J K, Heatwole E V, Strnad B T, Silber J S, Patzilk S B, Boorstein J M. Predictive value of intraosseous venography before percutaneous vertebroplasty.  J Vasc Interv Radiol. 2002;  13(2 Pt 1) 149-153
  CrossrefPubMedGoogle Scholar
• 49 Vasconcelos C, Gailloud P, Beauchamp N J, Heck D V, Murphy K J. Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutive procedures.  AJNR Am J Neuroradiol. 2002;  23 913-917
  PubMedGoogle Scholar
• 50 Munk P L, Rashid F, Heran M K et al.. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone.  J Vasc Interv Radiol. 2009;  20 903-911
  CrossrefPubMedGoogle Scholar
• 51 Molloy S, Riley III L H, Belkoff S M. Effect of cement volume and placement on mechanical-property restoration resulting from vertebroplasty.  AJNR Am J Neuroradiol. 2005;  26 401-404
  PubMedGoogle Scholar
• 52 Belkoff S M, Mathis J M, Jasper L E, Deramond H. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior.  Spine (Phila Pa 1976). 2001;  26 1537-1541
  CrossrefPubMedGoogle Scholar
• 53 Heini P F, Berlemann U. Bone substitutes in vertebroplasty.  Eur Spine J. 2001;  10(Suppl 2) S205-S213
  Google Scholar
• 54 Lieberman I H, Togawa D, Kayanja M M. Vertebroplasty and kyphoplasty: filler materials.  Spine J. 2005;  5(6 Suppl) 305S-316S
  CrossrefPubMedGoogle Scholar
• 55 Deramond H, Wright N T, Belkoff S M. Temperature elevation caused by bone cement polymerization during vertebroplasty.  Bone. 1999;  25(2 Suppl) 17S-21S
  CrossrefPubMedGoogle Scholar
• 56 Pomrink G J, DiCicco M P, Clineff T D, Erbe E M. Evaluation of the reaction kinetics of CORTOSS, a thermoset cortical bone void filler.  Biomaterials. 2003;  24 1023-1031
  CrossrefPubMedGoogle Scholar
• 57 Erbe E M, Clineff T D, Gualtieri G. Comparison of a new bisphenol-a-glycidyl dimethacrylate-based cortical bone void filler with polymethyl methacrylate.  Eur Spine J. 2001;  10(Suppl 2) S147-S152
  CrossrefPubMedGoogle Scholar
• 58 Bohner M. Physical and chemical aspects of calcium phosphates used in spinal surgery.  Eur Spine J. 2001;  10(Suppl 2) S114-S121
  CrossrefPubMedGoogle Scholar
• 59 Hitchon P W, Goel V, Drake J et al.. Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model.  J Neurosurg. 2001;  95(2 Suppl) 215-220
  PubMedGoogle Scholar
• 60 Nussbaum D A, Gailloud P, Murphy K. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site.  J Vasc Interv Radiol. 2004;  15 1185-1192
  CrossrefPubMedGoogle Scholar
• 61 Yeom J S, Kim W J, Choy W S, Lee C K, Chang B S, Kang J W. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures.  J Bone Joint Surg Br. 2003;  85 83-89
  CrossrefPubMedGoogle Scholar
• 62 Padovani B, Kasriel O, Brunner P, Peretti-Viton P. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty.  AJNR Am J Neuroradiol. 1999;  20 375-377
  PubMedGoogle Scholar
• 63 François K, Taeymans Y, Poffyn B, Van Nooten G. Successful management of a large pulmonary cement embolus after percutaneous vertebroplasty: a case report.  Spine (Phila Pa 1976). 2003;  28 E424-E425
  CrossrefPubMedGoogle Scholar
• 64 Choe D H, Marom E M, Ahrar K, Truong M T, Madewell J E. Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty.  AJR Am J Roentgenol. 2004;  183 1097-1102
  CrossrefPubMedGoogle Scholar
• 65 Scroop R, Eskridge J, Britz G W. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report.  AJNR Am J Neuroradiol. 2002;  23 868-870
  PubMedGoogle Scholar
• 66 Lin E P, Ekholm S, Hiwatashi A, Westesson P L. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.  AJNR Am J Neuroradiol. 2004;  25 175-180
  PubMedGoogle Scholar
• 67 Alfonso Olmos M, Silva González A, Duart Clemente J, Villas Tomé C. Infected vertebroplasty due to uncommon bacteria solved surgically: a rare and threatening life complication of a common procedure: report of a case and a review of the literature.  Spine (Phila Pa 1976). 2006;  31 E770-E773
  CrossrefPubMedGoogle Scholar
• 68 Vasconcelos C, Gailloud P, Martin J B, Murphy K J. Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty.  J Vasc Interv Radiol. 2001;  12 1001-1002
  CrossrefPubMedGoogle Scholar
• 69 Cloft H J, Easton D N, Jensen M E, Kallmes D F, Dion J E. Exposure of medical personnel to methylmethacrylate vapor during percutaneous vertebroplasty.  AJNR Am J Neuroradiol. 1999;  20 352-353
  PubMedGoogle Scholar
• 70 Peh W C, Gilula L A, Peck D D. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures.  Radiology. 2002;  223 121-126
  CrossrefPubMedGoogle Scholar
• 71 Cotten A, Boutry N, Cortet B et al.. Percutaneous vertebroplasty: state of the art.  Radiographics. 1998;  18 311-320 discussion 320-323
  PubMedGoogle Scholar
• 72 Kallmes D F, Comstock B A, Heagerty P J et al.. A randomized trial of vertebroplasty for osteoporotic spinal fractures.  N Engl J Med. 2009;  361 569-579
  CrossrefPubMedGoogle Scholar
• 73 Buchbinder R, Osborne R H, Ebeling P R et al.. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.  N Engl J Med. 2009;  361 557-568
  CrossrefPubMedGoogle Scholar
• 74 Noonan P. Randomized vertebroplasty trials: bad news or sham news?.  AJNR Am J Neuroradiol. 2009;  30 1808-1809
  CrossrefPubMedGoogle Scholar
• 75 Baerlocher M O, Munk P L, Radvany M G, Murphy T P, Murphy K J. Vertebroplasty, research design, and critical analysis.  J Vasc Interv Radiol. 2009;  20 1277-1278
  CrossrefPubMedGoogle Scholar
• 76 Munk P L, Liu D M, Murphy K P, Baerlocher M O. Effectiveness of vertebroplasty: a recent controversy.  Can Assoc Radiol J. 2009;  60 170-171
  CrossrefPubMedGoogle Scholar
• 77 Brown D B, Gilula L A, Sehgal M, Shimony J S. Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty.  AJR Am J Roentgenol. 2004;  182 319-322
  PubMedGoogle Scholar
• 78 Voormolen M H, Lohle P N, Juttmann J R, van der Graaf Y, Fransen H, Lampmann L E. The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty.  J Vasc Interv Radiol. 2006;  17 71-76
  CrossrefPubMedGoogle Scholar
• 79 Lin W C, Lee Y C, Lee C H et al.. Refractures in cemented vertebrae after percutaneous vertebroplasty: a retrospective analysis.  Eur Spine J. 2008;  17 592-599
  CrossrefPubMedGoogle Scholar
• 80 Trout A T, Kallmes D F. Does vertebroplasty cause incident vertebral fractures? A review of available data.  AJNR Am J Neuroradiol. 2006;  27 1397-1403
  PubMedGoogle Scholar
• 81 Lieberman I H, Dudeney S, Reinhardt M K, Bell G. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures.  Spine (Phila Pa 1976). 2001;  26 1631-1638
  CrossrefPubMedGoogle Scholar
• 82 Phillips F M, Ho E, Campbell-Hupp M et al.. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures.  Spine (Phila Pa 1976). 2003;  28 2260-2265
  CrossrefPubMedGoogle Scholar
• 83 Rao R D, Singrakhia M D. Painful osteoporotic vertebral fracture. Pathogenesis, evaluation, and roles of vertebroplasty and kyphoplasty in its management.  J Bone Joint Surg Am. 2003;  85-A 2010-2022
  PubMedGoogle Scholar
• 84 Mathis J M, Ortiz A O, Zoarski G H. Vertebroplasty versus kyphoplasty: a comparison and contrast.  AJNR Am J Neuroradiol. 2004;  25 840-845
  PubMedGoogle Scholar
• 85 Voormolen M H, Mali W P, Lohle P N et al.. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study.  AJNR Am J Neuroradiol. 2007;  28 555-560
  PubMedGoogle Scholar
• 86 McGirt M J, Parker S L, Wolinsky J P, Witham T F, Bydon A, Gokaslan Z L. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature.  Spine J. 2009;  9 501-508
  CrossrefPubMedGoogle Scholar
• 87 Wardlaw D, Cummings S R, Van Meirhaeghe J et al.. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial.  Lancet. 2009;  373 1016-1024
  CrossrefPubMedGoogle Scholar
• 88 Gill J B, Kuper M, Chin P C, Zhang Y, Schutt Jr R. Comparing pain reduction following kyphoplasty and vertebroplasty for osteoporotic vertebral compression fractures.  Pain Physician. 2007;  10 583-590
  PubMedGoogle Scholar
• 89 Taylor R S, Taylor R J, Fritzell P. Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety.  Spine (Phila Pa 1976). 2006;  31 2747-2755
  CrossrefPubMedGoogle Scholar
• 90 Liu J T, Liao W J, Tan W C et al.. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study.  Osteoporos Int. 2010;  21 359-364
  CrossrefPubMedGoogle Scholar
• 91 Eck J C, Nachtigall D, Humphreys S C, Hodges S D. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature.  Spine J. 2008;  8 488-497
  CrossrefPubMedGoogle Scholar
• 92 Cloft H J, Jensen M E. Kyphoplasty: an assessment of a new technology.  AJNR Am J Neuroradiol. 2007;  28 200-203
  PubMedGoogle Scholar
• 93 Hulme P A, Krebs J, Ferguson S J, Berlemann U. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies.  Spine (Phila Pa 1976). 2006;  31 1983-2001
  CrossrefPubMedGoogle Scholar
• 94 Whitlow C T, Mussat-Whitlow B J, Mattern C W, Baker M D, Morris P P. Sacroplasty versus vertebroplasty: comparable clinical outcomes for the treatment of fracture-related pain.  AJNR Am J Neuroradiol. 2007;  28 1266-1270
  CrossrefPubMedGoogle Scholar

Konstantinos KatsanosM.D. Ph.D. 

Interventional Radiologist, Radiology Department

Patras University Hospital, Patras, 26500 GR, Greece

Email: katsanos@med.upatras.gr