Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures.

Acrylic cements have been used for the augmentation of weakened or partially destroyed bones for decades (1). The term vertebroplasty originally described an open surgical procedure that introduces bone graft or acrylic cement to mechanically augment weakened vertebral bodies. Polymethylmethacrylate (PMMA) is the acrylic most commonly used as a bone filler, and its application in the treatment of pathologic vertebral compression fractures (VCFs) has been reported extensively (1–10). In particular, it has been used to treat VCFs created by metastatic disease and primary bone tumors, such as aggressive hemangiomas and giant cell tumors (11). The first image-guided percutaneous vertebral augmentation, or percutaneous vertebroplasty (PVP), was performed in France in 1984, when Deramond and Galibert (12) injected PMMA into a C2 vertebra that had been partially destroyed by an aggressive hemangioma. The procedure relieved the patient’s long-term pain. Shortly thereafter, PVP was used to treat VCFs caused by osteoporosis (13) (Fig 1). The interest in PVP has continued to grow since its introduction in Europe and its subsequent introduction in the United States by the interventional neuroradiology team at the University of Virginia (14). PVP reportedly offers the patient rapid relief from the pain associated with VCFs and is evolving as a standard of care for VCFs (15). In this review, we describe patient selection criteria, technical aspects of the procedure, and potential complications; review some of the basic science and biomechanics research related to the procedure; and present some future hurdles that still must be overcome for PVP to become a fully accepted standard of care.