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[Value of intraosseous venography in percutaneous vertebroplasty for treatment of symptomatic vertebral hemangiomas]

OBJECTIVE: To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) in patients with symptomatic vertebral hemangiomas and determine whether prior intraosseous venography decreases extravertebral leakage of PMMA and improves clinical outcomes in these procedures. METHODS: Retrospective review was conducted on 45 consecutive patients with 53 symptomatic vertebral hemangiomas associated with chronic pain (all cases) or paralysis caused by spinal cord compression (1 case) or vertebral compression fractures (3 cases) treated with PVP at our institution to define two populations. Group A consisted of 27 vertebral hemangiomas in 23 patients who underwent intraosseous venography before injection polymethylmethacrylate (PMMA). Group B consisted of 26 vertebrae in 22 patients who underwent injection PMMA without prior venography. CT was done 1 to 3 days after PVP to observe PMMA distribution in vertebrae and whether leakage. Clinical outcomes, included pain relief, leakage of PMMA, volume of PMMA injected, expense and X-ray exposure times in each vertebral body, were compared in the two groups by using chi(2) or t test. RESULTS: No significant difference was seen between the groups with respect to age, sex, the number of treated vertebrae, or preprocedural degrees of pain. The successful rate of technique of PVP was 100%. The mean volume of PMMA injected in each vertebra was 3.96 ml. CR, PR and NR was obtained respectively 84.5%, 13.3% and 2.2% during 6 months to 5 years of follow-up expect one case had unrelieved pain in group A. At 6 months after PVP, 22 cases (95.7%) in group A and 22 cases (100%) in group B achieved adequate pain relief (P = 0.323). 6 vertebrae (6/27) in group A and 2 vertebrae (2/26) in group B with asymptomatic leakage of PMMA were demonstrated by CT (P = 0.140). The mean volume of PMMA injected in each vertebra was 3.70 ml in group A and 4.23 ml in group B (P = 0.157). The mean expense of each vertebra was yen7.24 x 10(3) in group A and yen5.84 x 10(3) in group B (P = 0.000), the mean decreases were yen1.4 x 10(3) in group B than group A. The mean X-ray exposure times on each vertebral body was 13.28 minutes in group A and 8.78 minutes in group B (P = 0.000), the mean decreases were 4.5 minutes in group B than group A. CONCLUSIONS: PVP is an effective and safe procedure for treating symptomatic vertebral hemangiomas. Prior intraosseous venography does not significantly improve the effectiveness or safety of PVP for vertebral hemangiomas performed by qualified, experienced operators, on the other hand, it increases the expense and X-ray exposure times of PVP

Keywords : Adult,Aged,China,Chronic Pain,Female,Hand,Hemangioma,Humans,Male,methods,Middle Aged,Pain,Paralysis,Patients,Phlebography,Polymethyl Methacrylate,Radiology,Retrospective Studies,Safety,Spinal Cord,Spinal Cord Compression,Spinal Neoplasms,surgery,Time,Treatment Outcome,Universities,Vertebroplasty,, Intraosseous,Venography,Percutaneous, orthopedist london

Date of Publication : 2010 Dec 7

Authors : He SC;Teng GJ;Fang W;Deng G;Guo JH;Zhu GY;

Organisation : Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, China. shichenghe@vip.sina.com

Journal of Publication : Zhonghua Yi Xue Za Zhi

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21223765

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