Percutaneous vertebroplasty in patients with spinal canal compromise

The American College of Radiology Standard for Performance of Percutaneous Vertebroplasty lists as relative contraindications to the procedure conditions causing "significant spinal canal compromise." We believe percutaneous vertebroplasty can be performed safely and efficaciously in individuals without radicular symptoms who present with canal compromise, with or without cord compression.

We reviewed all vertebroplasties performed at our institution over the past 4 years. Cases in which vertebroplasty was performed at levels showing complete effacement of the epidural space, particularly those with cord compression, were included in the review. Follow-up data obtained from questionnaires routinely sent to our vertebroplasty patients were used to evaluate symptomatic response in this subset of patients as well as the occurrence of any complications.

Of 686 levels treated over the past 4 years, 26 levels in 23 patients qualified for our review. Follow-up ranged from 6 months to 2 years. Patients were asked to rate the degree of their original pain as follows: gone, better than, the same as, or worse than before the procedure. Of the 23 patients, five (22%) reported complete resolution of pain, 15 (65%) reported their symptoms to be better, and three (13%) reported no appreciable change. No complications with clinical sequelae were encountered.

Percutaneous vertebroplasty can be performed safely at levels showing spinal cord compression in patients without radicular signs. Most patients (87%) in our series showed some improvement or complete eradication of their symptoms. No patient reported worsening symptoms.