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Vertebroplasty: cement in the back!

2022-06-23T11:01:24.657Z

In the case of fractures caused by osteoporosis or cancerous lesions, vertebroplasty consolidates the spine. The pain is relieved.



Bones are not reeds;

under stress, they degrade.

This is particularly the case of the vertebrae.

After a fracture, most often of osteoporotic origin, they settle on each other, causing great suffering.

This usually ends up calming down after a few weeks or months of painkillers and corsets, but not always.

Other sources of violent pain: bone metastases from cancers or aggressive vertebral angiomas, which eat away at the structure of the bone, threatening the vertebral structure.

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To provide a solution to these pathologies, a technique was developed in France in the 1980s: the injection of cement into the bones or vertebroplasty.

It is now commonly practiced, especially in hospitals.

The cement used is an acrylic mixture whose composition has continued to improve over the years to preserve the biomechanical properties of the bone.

The intervention, most often performed in the event of an osteoporotic fracture, quickly reduces pain in 71 to 95% of cases.

It can also prevent the risk of fracture in the event of metastases or aggressive angiomas, also relieving the severe pain associated with these diseases.

Its effectiveness in the field of osteoporosis has recently been discussed.

While this type of intervention has been widely used in France and abroad, research studies believe that it does not provide any benefit compared to a placebo: to establish this, in a study dating from 2018 , the doctors performed a fake vertebroplasty so that the patients did not know whether or not they had received the cement.

Vertebroplasty rapidly reduces pain in some patients who have been in severe pain for several weeks and whose fractures do not heal on imaging

Bernard Cortet, rheumatologist at Lille University Hospital

“Vertebroplasty remains useful and effective in very specific indications,

considers Bernard Cortet, rheumatologist at the University Hospital of Lille and president of the research and information group on osteoporosis (Grio).

This intervention has been practiced a lot, perhaps in excess in patients who are too young – or too hastily – even before the pain has had time to decrease.

She must find her rightful place.

It rapidly reduces pain in some patients who have been in severe pain for several weeks, and whose fractures do not heal on imaging.

In particular, in the elderly who can tolerate strong analgesics poorly.

And in the event of bone metastases, the effect is palliative, but significant because the pain induced is very intense and the bone extremely weakened, which makes it possible to consolidate it and avoid a break which could have neurological consequences”.

he explains.

Given the debate, the French Society of Rheumatology and the Grio are preparing a "positioning paper" for practitioners to clearly re-specify the relevant indications.

Osteoporosis treatment is required

In practice, the operation is performed by a radiologist under local or general anesthesia depending on the center and the patient's choice.

Guided by a scanner, he places a trocar (a cylindrical rod that is pointed and sharp at its end) in the vertebra to be treated, then injects the cement into it.

Up to three vertebrae can be treated at a time.

The intervention can be carried out on an outpatient basis or within the framework of a 24-hour hospitalization.

Sometimes, when an unbroken vertebra is found between two others that are, the practitioner can choose to consolidate it also for prevention.

Subsequently, the cement remains in place for years and does not affect the mobility of the back, since only the vertebra is affected.

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On the other hand, the intervention can do nothing against the risk of a new fracture near the consolidated site.

Note that the risk of complication is not zero due to cement leaking out of the vertebra.

“This risk is very low in the case of consolidation of osteoporotic fractures, but exists during the treatment of metastases due to the porosity of the bone linked to its fragility.

The cement can then reach a disc or the spinal cord.

It is necessary to study the risk-benefit of this intervention, ”

says Bernard Cortet.

He also recalls that vertebroplasty does not in any way replace antiosteoporotic treatment.

Source: lefigaro

All news articles on 2022-06-23

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