A variation of vertebroplasty, called kyphoplasty, has recently been gaining popularity, particularly in the surgical community. In this procedure, cannulas are placed down both pedicles, and two inflatable bone tamps are inserted into the vertebral body. The bone tamps are inflated to >200 psi, the trabeculae are crushed, and a cavity is created. The tamps are removed and the cavity is filled with viscous cement. Proponents of this technique state that it is safer than vertebroplasty because the cement filling is done under low pressure and therefore less extravasation and fewer complications occur (74,75). No bio-mechanical or clinical data exist to support this claim. In fact, one symptomatic pulmonary embolus has been reported (76), and in the only published, peer-reviewed study of 30 patients, one suffered a myocardial infarction (75). Minimal height restoration in some vertebral bodies has also been noted (75). However, positive outcomes as determined by pain relief and improved mobility are similar to the vertebroplasty experience, and there are no data to support the argument that minimal height restoration is an added benefit. Furthermore, the bone tamps are very expensive, and most operators perform the procedure with the patient under general anesthesia followed by a short-stay hospital admission. The increases in risk and cost are

Vertebral Tumor Embolization

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Fig. 10. (A-C) Sixty-year-old male with renal cell metastasis to L4 and left leg radiculopathy. Axial T1-weighted MR (A) shows epidural tumor spread through the posterior wall and into the left lateral recess. Following transarterial embolization, the patient's pain resolved but 4 mo later he developed back pain due to fracture through the vertebral body. During vertebroplasty, some of the cement was noted to extend posterior to the posterior vertebral wall (B, arrow). The patient developed left leg pain shortly thereafter. CT scan (C) showed a small amount of cement within the tumor mass in the lateral recess. After a short course of oral steroids, the patient's pain subsided.

Ventilated Short Course Body

not justified by the questionable benefits of kyphoplasty, and more serious study must be performed before it is accepted as an alternative to or improvement on vertebro-plasty.

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