AJR: Vesselplasty offers new technique for vertebral compression fractures

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Vesselplasty, a new minimally invasive, image-guided procedure, increases mobility and reduces pain and the need for pain killers in patients with vertebral compression fractures (VCFs), according to a study in the July issue of the American Journal of Roentgenology.

Vesselplasty is an alternative to vertebroplasty and kyphoplasty--two conventional VCF treatment methods. Instead of using a balloon to create a cavity, vesselplasty uses a polyethylene terephthalate balloon container (Vessel-X, A-Spine Holding Group of Taipei, Tawain) to restore the height of the vertebral body.

The authors said that the receptacle serves as both a vertebral body expander and a bone cement container. In an image-guided procedure, it is introduced into the vertebra in its reduced configuration and, once positioned within the vertebra, is expanded by the injection of polymethylmethacrylate. Then, a small amount of bone cement permeates through its wall and interdigitates within the vertebral body to increase its stability.

"Vesselplasty solves the problem of leakage of cement out of the vertebral body which can happen during both vertebroplasty and kyphoplasty," said the study's lead author, Lucia Flors, MD, from the Hospital Universitario Doctor Peset in Valencia, Spain.

The study included 29 patients with VCFs who underwent vesselplasty between April 2006 and February 2008. Because primary osteoporosis was the dominant cause of the treated VCFs in the study group, the authors wrote that 70 percent of the participants were older than 65 years and 65.5 percent were women.

"After the procedure, all patients had improvements in their pain scores; 93 percent of patients had improvements in mobility; and 62 percent of patients had a decreased need for pain killers," Flors said.

The average pain score before treatment was 8.72, whereas the average pain score after treatment was 3.38, according to the researchers. The average mobility score before treatment was 2.31, whereas the average mobility score after treatment was 0.59.

The authors also noted that here was no evidence of clinical complications following the procedure.

Radiologically, Flors and colleagues wrote that vertebral height restoration was observed in six of the 37 treated vertebrae, remaining unchanged in the others.

"In the cases in which an increase was achieved, the change was noted throughout the whole vertebral body. Minimal augmentation in height was achieved in our study (mean, 0.47 mm), and height in most of the vertebral bodies remained unchanged," they wrote.