Osteoporotic vertebral fractures: natural history and impact. / Fracturas vertebrales osteoporóticas: historia natural e impacto.

Osteoporosis, and the consequences derived from it, such as fragility fractures, constitute a growing public health problem. Suffering from a fracture of this nature is the main risk factor for suffering a new fracture. It is documented that vertebral compression fractures lead to significant morbidity and mortality, in the short and long term, as well as other complications, such as sagittal imbalance and hyperkyphosis of the segment. However, we have not found documentation that analyzes the medium and long-term consequences of these injuries, assessing the type of treatment used, and the economic impact they represent. The purpose of this review is to analyze the main recent literature on the subject and make a breakdown of the consequences of these fractures in various spheres, such as economic, quality of life, sagittal balance and radiographic parameters, pain or mortality; as well as a brief analysis of epidemiology and natural history. Conclusion: Osteoporotic fractures constitute an emerging problem, both in the medical and economic fields. The consequences and sequelae on the patient are multiple and although surgical options offer good long-term results, it is necessary to properly select the patient, through multidisciplinary teams, to try to minimize potential complications.

[Translated article] Relation between the volume of injected cement and the vertebral volume in the clinical outcome and in the appearance of leakage after a percutaneous vertebroplasty.

OBJECTIVES: To assess the connection between the volume of injected cement and the vertebral volume measured through a volumetric analysis with a computed tomography (CT scan) in relation to the clinical result and the appearance of a leakage in patients who underwent a percutaneous vertebroplasty after an osteoporotic fracture. MATERIALS AND METHODS: A prospective study of 27 patients (18 female-9 male) with an average age of 69 years old (50-81), and with a one-year follow-up. The study group presented 41 vertebrae with osteoporotic fractures that were treated with a percutaneous vertebroplasty with a bilateral transpedicular approach. The volume of injected cement was registered in each procedure and it was assessed together with the spinal volume measured through a volumetric analysis with CT scans. The percentage of the spinal filler was calculated. The appearance of cement leakage was proved by means of a simple radiography and a postoperative CT scan in all the cases. The leaks were classified according to the location in relation to the vertebral body (posterior, lateral, anterior and in the disc), and the significance (minor: smaller than the largest diameter of the pedicle; moderate: larger than the pedicle but smaller than the height of the vertebra; major: larger than the height of the vertebra). RESULTS: The average vertebra volume was 26.1cm3, the average volume of the injected cement was 2.0cm3 and the percentage of the average filler was 9%. A total of 15 leaks in 41 vertebrae appeared (37%). The leaks were posterior in 2 vertebrae, vascular in 8 and into the disc in 5 vertebrae. They were deemed as minor in 12 cases, moderate in 1 and major in 2 cases. The preoperative assessment of the pain was as it follows: VAS (8) and Oswestry (67%). The cessation of pain was immediate after a year with the following postoperative results: VAS (1.7) and Oswestry (19%). The only complication was the temporary neuritis with a spontaneous resolution. CONCLUSIONS: The injection of small amounts of cement, lower than the ones referred to by literary sources, obtains clinical results similar to the ones obtained by injecting higher amounts and it reduces the number of cement leaks and further complications.

Relation between the volume of injected cement and the vertebral volume in the clinical outcome and in the appearance of leakage after a percutaneous vertebroplasty. / Relación entre el volumen de cemento inyectado y el volumen vertebral en el resultado clínico y en la aparición de fugas tras vertebroplastia percutánea.

OBJECTIVES: To assess the connection between the volume of injected cement and the vertebral volume measured through a volumetric analysis with a computed tomography (CT scan) in relation to the clinical result and the appearance of a leakage in patients who underwent a percutaneous vertebroplasty after an osteoporotic fracture. MATERIALS AND METHODS: A prospective study of 27 patients (18 female-9 male) with an average age of 69 years old (50-81), and with a one-year follow-up. The study group presented 41 vertebrae with osteoporotic fractures that were treated with a percutaneous vertebroplasty with a bilateral transpedicular approach. The volume of injected cement was registered in each procedure and it was assessed together with the spinal volume measured through a volumetric analysis with CT scans. The percentage of the spinal filler was calculated. The appearance of cement leakage was proved by means of a simple radiography and a postoperative CT scan in all the cases. The leaks were classified according to the location in relation to the vertebral body (posterior, lateral, anterior and in the disc), and the significance (minor: smaller than the largest diameter of the pedicle; moderate: larger than the pedicle but smaller than the height of the vertebra; major: larger than the height of the vertebra). RESULTS: The average vertebra volume was 26.1 cc, the average volume of the injected cement was 2.0 cc and the percentage of the average filler was 9%. A total of 15 leaks in 41 vertebrae appeared (37%). The leaks were posterior in 2 vertebrae, vascular in 8 and into the disc in 5 vertebrae. They were deemed as minor in 12 cases, moderate in 1 and major in 2 cases. The preoperative assessment of the pain was as it follows: VAS (8) and Oswestry (67%). The cessation of pain was immediate after a year with the following postoperative results: VAS (1.7) and Oswestry (19%). The only complication was the temporary neuritis with a spontaneous resolution. CONCLUSIONS: The injection of small amounts of cement, lower than the ones referred to by literary sources, obtains clinical results similar to the ones obtained by injecting higher amounts and it reduces the number of cement leaks and further complications.

Caracterización de pacientes con mieloma múltiple y afectación de la columna vertebral atendidos en un hospital de tercer nivel de Medellín, Colombia / Characterization of patients with multiple myeloma and spinal cord involvement treated at a tertiary care center in Medellín, Colombia

Introducción: el mieloma múltiple (MM) es un tipo de cáncer que se genera en células plasmáticas y puede provocar la destrucción del tejido óseo. Aproximadamente el 50% de los pacientes con esta enfermedad experimentarán fracturas vertebrales secundarias. Objetivo: describir las características de pacientes con MM y afectación de la columna vertebral atendidos en un hospital de tercer nivel.Metodología: estudio descriptivo retrospectivo realizado con los datos de pacientes con MM y afectación de la columna vertebral atendidos entre 2014 y 2018 en un hospital de tercer nivel de atención de Medellín, Colombia. Se obtuvieron datos sociodemográficos y clínicos. Las variables cuantitativas se describen usando medias y desviaciones estándar, mientras que las cualitativas, frecuencias absolutas y porcentajes con su respectivo intervalo de confianza (IC95%).Resultados: la muestra consistió de 109 pacientes. La edad media fue 63 años, la distribución de sexo fue 1:1, el 78,9% de los participantes fue diagnosticado de novo y el síntoma más frecuente fue dolor lumbar (47%). Además, se encontró una media de 5 niveles (cuerpos vertebrales) afectados, el método de diagnóstico de estas lesiones más frecuente fue la tomografía (62%) y solo el 26% de los pacientes presentaron algún tipo de lesión neurológica. En lo que respecta al tratamiento, 95%, 46%, 55% y 13% fueron tratados con quimioterapia, radioterapia, bifosfonatos e intervención quirúrgica, respectivamente.Conclusiones: las características de la muestra son similares a las reportadas en otras investigaciones, a excepción de la distribución del sexo. Además, se identificó una baja frecuencia de tratamiento quirúrgico

Introduction: Multiple myeloma (MM) is a type of cancer that originates in plasma cells and can lead to the destruction of bone tissue. Approximately 50% of patients with this condition will experience secondary vertebral fractures. Objective: To characterize patients with MM and spine involvement treated at a tertiary care center.Methodology: Retrospective, descriptive study conducted using data from patients with MM and spinal involvement treated between 2014 and 2018 in a tertiary care center in Medellín, Colombia. Sociodemo-graphic and clinical data were obtained. Quantitative variables are described using means and standard deviations, while qualitative variables are presented as absolute frequencies and percentages with their respective confidence interval (CI95%).Results: The sample consisted of 109 patients, with a mean age of 63 years and a sex ratio of 1:1. In addition, 78.9% of the participants were newly diagnosed and the most frequent symptom was low back pain (47%). It was also found that an average of 5 sections (vertebral bodies) were affected, that the most frequent method of diagnosis of these lesions was tomography (62%), and that only 26% of the patients presented with some type of brain lesion. Regarding treatment, 95%, 46%, 55%, and 13% were treated with chemotherapy, radiotherapy, bisphosphonates, and surgery, respectively.Conclusions: The characteristics of the sample are similar to those reported in other studies, with the exception of sex ratio. Moreover, a low frequency of surgical treatment was observed

Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica / Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture

Antecedentes y objetivos: La correlación entre el equilibrio sagital de la columna y el resultado clínico tras una vertebroplastia (VP) en pacientes con fractura vertebral osteoporótica por compresión (FVOC) ha sido poco estudiada. Analizamos el resultado clínico de la VP en pacientes con FVOC teniendo en cuenta el equilibrio sagital. Material y método: El objetivo primario es valorar el cambio en el dolor axial, la discapacidad y la calidad de vida relacionada con la salud mediante la escala analógica visual (VAS), índice de discapacidad de Oswestry (ODI) y el test SF-36, respectivamente. Todo ello, correlacionado con el eje sagital vertical (SVA) que define el equilibrio sagital. El estudio radiográfico consistió en una radiografía de perfil de columna completa en bipedestación. Los controles clínico-radiológicos se realizaron pre- y post-VP (1, 3 y 12 meses). Resultados: Se incluyeron 51 pacientes con un total de 113 FVOC; 30 pacientes (60,7%) presentaron múltiples FVOC. Comparando la evolución del resultado del VAS y del ODI durante el seguimiento no se observaron diferencias significativas entre los grupos de pacientes con SVA<50mm y >50mm (p>0,05). Por el contrario, en pre-VP los resultados del SF-36 presentaban peores puntuaciones en el grupo de SVA>50mm en la sección de función física (FP) (p<0,05) y de componente de salud física (CSF) (p<0,05). Estas diferencias se mantenían hasta los 3 meses de seguimientos en CSF y hasta el final del seguimiento en la sección de FP (p<0,05). Conclusiones: Los pacientes con SVA>50mm presentan una recuperación más lenta de su calidad de vida relacionada con la salud tras VP por FVOC, pero sin diferencias significativas con respecto al dolor o discapacidad cuando se comparan con pacientes con SVA<50mm.(AU)

Background and objectives: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. Material and method: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. Results: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). Conclusions: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.(AU)

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica

Antecedentes y objetivos: La correlación entre el equilibrio sagital de la columna y el resultado clínico tras una vertebroplastia (VP) en pacientes con fractura vertebral osteoporótica por compresión (FVOC) ha sido poco estudiada. Analizamos el resultado clínico de la VP en pacientes con FVOC teniendo en cuenta el equilibrio sagital. Material y método: El objetivo primario es valorar el cambio en el dolor axial, la discapacidad y la calidad de vida relacionada con la salud mediante la escala analógica visual (VAS), índice de discapacidad de Oswestry (ODI) y el test SF-36, respectivamente. Todo ello, correlacionado con el eje sagital vertical (SVA) que define el equilibrio sagital. El estudio radiográfico consistió en una radiografía de perfil de columna completa en bipedestación. Los controles clínico-radiológicos se realizaron pre- y post-VP (1, 3 y 12 meses). Resultados: Se incluyeron 51 pacientes con un total de 113 FVOC; 30 pacientes (60,7%) presentaron múltiples FVOC. Comparando la evolución del resultado del VAS y del ODI durante el seguimiento no se observaron diferencias significativas entre los grupos de pacientes con SVA<50mm y >50mm (p>0,05). Por el contrario, en pre-VP los resultados del SF-36 presentaban peores puntuaciones en el grupo de SVA>50mm en la sección de función física (FP) (p<0,05) y de componente de salud física (CSF) (p<0,05). Estas diferencias se mantenían hasta los 3 meses de seguimientos en CSF y hasta el final del seguimiento en la sección de FP (p<0,05). Conclusiones: Los pacientes con SVA>50mm presentan una recuperación más lenta de su calidad de vida relacionada con la salud tras VP por FVOC, pero sin diferencias significativas con respecto al dolor o discapacidad cuando se comparan con pacientes con SVA<50mm.(AU)

Background and objectives: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. Material and method: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. Results: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). Conclusions: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.(AU)

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. METHODS: The primary endpoint was the change in axial back pain; disability and health-related quality of life using VAS, ODI and SF-36 respectively in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre and post procedure at 1, 3 and 12 months. RESULTS: Fifty-one patients were included presenting a total of 113 OVCF. Thirty patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, preVP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning section (PF) (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality of life after VP for OVCF, but without significant differences with respect to pain or disability, when compared with patients with SVA<50mm.

Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture. / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. MATERIAL AND METHOD: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. RESULTS: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.

Vertebroplastia percutánea en fracturas vertebrales osteoporóticas / Percutaneous vertebroplasty for osteoporotic vertebral fractures

La osteoporosis es una enfermedad sistémica que deteriora la calidad del hueso y su arquitectura. Como consecuencia, predispone a fracturas por fragilidad, entre las cuales las fracturas vertebrales son frecuentes. Estas se asocian a una gran morbimortalidad. La vertebroplastia ha surgido en 1984 como alter-nativa terapéutica para tratar algunos tumores vertebrales y fracturas vertebrales osteoporóticas dolorosas. Este procedimiento consiste en la inyección de cemento guiado por imágenes, para estabilizar la vértebra fracturada y disminuir el dolor. La vertebroplastia puede ser realizada con anestesia local, sedación o anestesia general. La fuga de cemento fuera de la vértebra es una complicación común; sin embargo esto no suele tener traducción clínica y solamente se trata de un hallazgo imagenológico. En este artículo revisaremos las indicaciones, contraindicaciones, la eficacia, controversias y las complicaciones de la vertebroplastia percutánea. (AU)

Osteoporosis is a systemic disease characterized by bone quality deterioration. As a consequence of this deterioration, osteoporosis results in high fracture risk due to bone fragility. Fractures to the spine are common in this scenario, and relate to an increased morbi-mortality. Vertebroplasty emerged in 1984 as an alternative to treat painful vertebral tumors and osteoporotic vertebral fractures. This procedure relies on image guided cement injection to achieve pain relief and strengthen the vertebral body. Vertebroplasty can be performed under local anesthesia, mild sedation, or general anesthesia. Among its complications, cement leakage is common but it is rarely associated with any symptoms and it is usually an imaging finding. In this article, we will review indications and contraindications, effectiveness, controversies and complications related to percutaneous vertebroplasty. (AU)

Osteoporotic spine fractures treated with kyphoplasty or vertebroplasty: a meta-analysis / Fraturas osteoporóticas da coluna tratados com cifoplastia ou vertebroplastia: uma metanálise / Fracturas osteoporóticas de la columna vertebral tratadas con cifoplastía o vertebroplastía: un metaanálisis

ABSTRACT Kyphoplasty (KP) and vertebroplasty (VP) are both widely adopted treatments for patients with osteoporotic vertebral fractures (OVF), however, which of these techniques is more effective has not yet been established. We performed a systematic review of articles, followed by meta-analysis, in an attempt to establish the differences between KP and VP. Initially, 187 articles were obtained, 20 of which were systematically reviewed and submitted to meta-analysis. Thus, 2,226 patients comprised the universe of the present article, 1202 of whom underwent KP and 1024 of whom underwent VP. The statistically significant results observed included lower mean bone cement leakage (ml) in the group submitted to kyphoplasty, with OR: 1.50 [CI95%: 1.16 - 1.95], p <0.05; shorter mean surgical time (minutes), 0.45 [CI90% 0.08 - 0.82], p <0.1, for the group submitted to VP as compared to the KP group; and a lower mean postoperative Oswestry Disability Index score in the KP group, OR: −0.14 [CI95%: −0.28 - 0.01], p <0.05. KP was more effective in improving physical function and had a lower frequency of cement leakage when compared to VP, although it requires longer surgical time. Level of evidence III; Systematic review of level III studies.

RESUMO Tanto a cifoplastia (KP) quanto a vertebroplastia (VP) são tratamentos bastante adotados para pacientes com fratura vertebral osteoporótica (FVO), no entanto, ainda não foi estabelecido qual destas é a técnica de maior eficácia. Realizamos uma revisão sistemática de artigos, seguida de metanálise, na tentativa de estabelecer as diferenças entre KP e VP. Foram obtidos inicialmente 187 artigos, sendo que destes, 20 foram revisados sistematicamente e submetidos à metanálise. Assim, 2226 pacientes compuseram o universo do presente artigo, sendo 1202 destes submetidos à KP e 1024 à VP. Entre os resultados estatisticamente significativos, foi observado um menor extravasamento médio de cimento ósseo (ml) no grupo submetido à cifoplastia, OR: 1,50 [IC 95%: 1,16 - 1,95], p < 0,05; o tempo médio de operação (minutos) 0,45 [IC 90%: 0,08 - 0,82], p < 0,1, na comparação entre KP e VP é menor no grupo submetido à vertebroplastia e no pós-cirúrgico, o Índice Médio de Incapacidade de Oswestry foi menor no grupo KP OR: −0,14 [IC 95% −0,28 - 0,01], p < 0,05. A KP foi mais eficaz na melhora da função física e menor frequência de extravasamento de cimento quando comparada à VP embora demande maior tempo cirúrgico. Nível de evidência III; Revisão sistemática de estudos de nível III.

RESUMEN Tanto la cifoplastía (KP) como la vertebroplastía (VP) son tratamientos ampliamente adoptados en pacientes con fractura vertebral osteoporótica (FVO), sin embargo, aún no se ha establecido cuál de ellas es la técnica más eficaz. Se realizó una revisión sistemática de artículos, seguida de un metaanálisis, en un intento de establecer las diferencias entre KP y VP. Inicialmente se obtuvieron 187 artículos, de los cuales 20 fueron revisados sistemáticamente y sometidos a un metaanálisis. Así, 2226 pacientes constituyeron el universo del presente artículo, 1202 de ellos sometidos a KP y 1024 a VP. Entre los resultados estadísticamente significativos, se observó una menor extravasación media de cemento óseo (ml) en el grupo sometido a cifoplastía, OR: 1,50 [IC 95%: 1,16 - 1,95], p <0,05; el tiempo medio de intervención (minutos) 0,45 [IC 90% 0,08 - 0,82], p <0,1, en la comparación entre KP y VP es menor en el grupo sometido a vertebroplastía y en el posquirúrgico, el Índice de Discapacidad de Oswestry promedio fue menor en el grupo KP OR: −0,14 [IC 95 % CI −0,28 - 0,01], p <0,05. La KP fue más eficaz en la mejora de la función física y con menor frecuencia de extravasación de cemento en comparación con la VP, aunque requiere un tiempo quirúrgico más prolongado. Nivel de evidencia III; Revisión sistemática de estudios de nivel III.

Kyphoplasty versus vertebroplasty in vertebral compression fractures: a meta-analysis / Cifoplastia vs. vertebroplastia em fraturas por compressão vertebral: uma metanálise / Cifoplastia versus vertebroplastia en fracturas por compresión vertebral: un metaanálisis

ABSTRACT Introduction: Vertebral fracture is the main complication of osteoporosis and is common among the elderly. Conservative treatment is the first choice for osteoporotic vertebral compression fractures (OVCF) but for persistent painful cases, percutaneous vertebral cement augmentation techniques, such as vertebroplasty and kyphoplasty, are indicated. We performed a systematic review to compare clinical and radiological outcomes of both methods. Methods: A systematic review was performed according to the PRISMA and Cochrane Handbook for Systematic Reviews of Interventions. The PICO search strategy consisted of the following terms: Population- Patients with OVCFs; Intervention- Kyphoplasty; Control- Vertebroplasty; Outcomes- Pain, Cement Leakage, Vertebral Body Height, Adjacent level fractures, Oswestry (ODI) and SF36. Results: Seven articles were included in the qualitative analysis, selecting only randomized controlled trials. Four hundred and fifty patients were treated with vertebroplasty (VP) and 469 with kyphoplasty (KP). The leakage rate of the VP group was 63% versus 14% for the KP group. However, these results were without statistical significance. The Visual Analogue Scale (VAS), ODI and SF-36 outcomes were evaluated based on the 6-month and 1-year follow-up results, and we were unable to find any significant differences between treatments. For restoration of vertebral height, the values of the KP group were, on average, 0.71 cm higher than those of the VP group, with 95% CI. Conclusion: Based on this systematic review, kyphoplasty is superior to vertebroplasty for achieving gains in vertebral body height. As regards cement leakage and other clinical outcomes, neither method showed statistically significant superiority. Level of Evidence I; Systematic review.

RESUMO Introdução: A fratura vertebral é a principal complicação da osteoporose e ocorre com frequência em idosos. O tratamento conservador é a primeira escolha para fraturas compressivas vertebrais por osteoporose (FCVO), mas para casos dolorosos persistentes, as técnicas de cimentação vertebral, como vertebroplastia e cifoplastia, são indicadas. Realizamos uma revisão sistemática para comparar os resultados clínicos e radiológicos de ambos os métodos. Métodos: Uma revisão sistemática foi realizada de acordo com o PRISMA e o Manual Cochrane de Revisões Sistemáticas. A estratégia de busca PICO foi: População - Pacientes com FCVOs; Intervenção - Cifoplastia; Controle - Vertebroplastia; Resultados - Dor, Extravazamento de Cimento, Altura do Corpo Vertebral, Fraturas em Nível Adjacente, Oswestry (ODI) e SF36. Resultados: Sete artigos foram incluídos na análise qualitativa, somente ensaios clínicos randomizados. Quatrocentos e cinquenta pacientes foram tratados com vertebroplastia (VP) e 469 com cifoplastia (CP). A taxa de extravazamento de cimento do grupo VP foi de 63% contra 14% do CP, no entanto, não atingiu significância estatística. Os desfechos da Escala Visual Analógica (EVA), ODI e SF-36 foram avaliados considerando os resultados de seis meses e um ano de seguimento e não pudemos apontar diferenças entre os tratamentos. Por fim, a CP apresenta valores médios 0,71 cm maiores do que a VP para a restauração da altura do corpo vertebral, com IC de 95%. Conclusão: Nesta revisão sistemática a cifoplastia foi superior à vertebroplastia para ganho de altura do corpo vertebral. Não houve superioridade estatisticamente significativa entre os dois métodos para extravazamento de cimento e outros resultados clínicos. Nível de Evidência I; Revisão sistemática

RESUMEN Introducción: La fractura vertebral es la principal complicación de la osteoporosis y ocurre con frecuencia en los ancianos. El tratamiento conservador es la primera opción para las fracturas vertebrales por compresión debidas a la osteoporosis (FCVO), pero para los casos de dolor persistente están indicadas las técnicas de cementación vertebral, como la vertebroplastia y la cifoplastia. Se realizó una revisión sistemática para comparar los resultados clínicos y radiológicos de ambos métodos. Métodos: Se llevó a cabo una revisión sistemática de acuerdo con la declaración PRISMA y el Manual Cochrane de Revisiones Sistemáticas. La estrategia de búsqueda PICO fue: Población: Pacientes con FCVO; Intervención: Cifoplastia; Control- Vertebroplastia; Resultados: Dolor, Extravasación del cemento, Altura del Cuerpo Vertebral, Fracturas de Nivel Adyacente, Oswestry (ODI) y SF36. Resultados: Se incluyeron siete artículos en el análisis cualitativo, sólo ensayos clínicos aleatorios. Cuatrocientos cincuenta pacientes fueron tratados con vertebroplastia (VP) y 469 con cifoplastia (CP). La tasa de extravasación de cemento en el grupo VP fue del 63% frente al 14% en el CP, sin embargo, no alcanzó significancia estadística. Los resultados de la Escala Visual Analógica (EVA), ODI y SF-36 se evaluaron teniendo en cuenta los resultados de 6 meses y 1 año de seguimiento y no pudimos señalar diferencias entre los tratamientos.. Finalmente, el CP presenta valores promedios 0,71 cm superiores al VP para restaurar la altura del cuerpo vertebral, con un IC del 95%. Conclusión: En esta revisión sistemática, la cifoplastia fue superior a la vertebroplastia para el aumento de altura del cuerpo vertebral. No hubo una superioridad estadísticamente significativa entre los dos métodos para la extravasación del cemento y otros resultados clínicos. Nivel de Evidencia I; Revisión sistemática.

Vertebroplasty in bone fragility fractures and tumor fractures: risks and benefits / Vertebroplastia em fraturas por fragilidade óssea e tumorais: riscos e benefícios / Vertebroplastia en fracturas por fragilidad ósea y tumorales: riesgos y beneficios

ABSTRACT Objective: To evaluate the results of percutaneous vertebroplasty (PV) in spinal fragility fractures (osteoporosis/tumor), analyzing possible complications. Method: We evaluated 33 patients with spinal fractures (FXV) due to osteoporosis or tumor who underwent PV between January and November 2021. A physical examination was performed, obtaining the history and risk factors for bone fragility/tumor and a radiological evaluation of the spine to verify FXV. Genant's semiquantitative method was used for postoperative classification, the VAS score, and a disability questionnaire (ODI). A radiologist evaluated tomographic control to quantify vertebral filling and extravasation, determining where they occurred. Results: 46 vertebrae of 33 patients were operated on, with a mean age of 71 years, and 11 patients with more than one level of surgery. Of the total, 13 patients had tumor fractures, and 20 had fractures due to insufficiency. PMMA extravasation was observed in 31 vertebrae, most frequently in the External Vertebral Venous Plexus (23), Discal Body (9), Anterior Epidural Recess (4), Pulmonary Vessels (4), Internal Vertebral Venous Plexus (3), Inferior Cava (2), Adipose Plane (2) and Azygos Vein (1). No patient had clinical complications. Furthermore, the mean preoperative VAS was eight, the postoperative one was 3, the mean preoperative ODI was 56, and the postoperative one was 30. Conclusion: PMMA extravasation was frequent in several locations and levels without any clinical complications. VP proved to be effective in improving pain and function. Level III; Longitudinal Retrospective Cohort Study.

RESUMO Objetivo: Avaliar os resultados da vertebroplastia percutânea (VP) em fraturas por fragilidade da coluna (osteoporose/tumoral), analisando possíveis complicações. Método: Foram avaliados 33 pacientes com fratura da coluna vertebral (FXV) por osteoporose ou tumor, entre janeiro e novembro de 2021, submetidos à VP. Foi realizado exame físico junto à obtenção da história e fatores de risco para fragilidade óssea / tumor, além de avaliação radiológica da coluna para constatação de FXV. O método semiquantitativo de Genant foi empregado para a classificação no pós-operatório, além do score EVA e do questionário de incapacidade (ODI). O controle tomográfico foi avaliado por médico radiologista para quantificação do preenchimento vertebral e extravasamento, determinando para onde ocorreram. Resultados: Foram operadas 46 vértebras de 33 pacientes, como média de idade de 71 anos, sendo 11 pacientes com mais de um nível operado. Do total, 13 pacientes apresentavam fraturas tumorais e 20 possuíam fraturas por insuficiência. Observou-se extravasamento do PMMA em 31 vértebras, mais frequentemente para Plexo Venoso Vertebral Externo (23), Corpo Discal (9), Recesso Epidural Anterior (4) Vasos Pulmonares (4), Plexo Venoso Vertebral Interno (3), Cava Inferior (2), Plano Adiposo (2) e Veia Ázigos (1). Nenhum paciente apresentou complicações clínicas. Ainda, o EVA pré-operatório médio foi 8 e o pós-operatório de 3, enquanto o ODI pré-operatório médio foi de 56 e o pós-operatório de 30. Conclusão: O extravasamento de PMMA foi frequente em diversos locais e níveis, sem nenhuma complicação clínica. A VP mostrou-se eficaz na melhora de dor e função. Nível III; Estudo Longitudinal Coorte Retrospectivo.

RESUMEN Objetivo: Evaluar los resultados de la vertebroplastia percutánea (PV) en fracturas por fragilidad de columna (osteoporosis/tumor), analizando posibles complicaciones. Método: Se evaluaron 33 pacientes con fractura de columna (FXV) por osteoporosis o tumor, entre enero y noviembre de 2021, que fueron sometidos a PV. Se realizó examen físico junto con obtención de antecedentes y factores de riesgo de fragilidad ósea/tumor, además de evaluación radiológica de columna para verificar FXV. Para la clasificación postoperatoria se utilizó el método semicuantitativo de Genant, además de utilizar la escala EVA y un cuestionario de discapacidad (ODI). El control tomográfico fue evaluado por un radiólogo para cuantificar el llenado vertebral y la extravasación, determinando dónde se producían. Resultados: Se operaron 46 vértebras de 33 pacientes, con una edad promedio de 71 años, 11 pacientes con más de un nivel de cirugía. Del total, 13 pacientes presentaron fracturas tumorales y 20 fracturas por insuficiencia. Se observó extravasación de PMMA en 31 vértebras, con mayor frecuencia en el Plexo Venoso Vertebral Externo (23), Cuerpo Discal (9), Receso Epidural Anterior (4), Vasos Pulmonares (4), Plexo Venoso Vertebral Interno (3), Cava Inferior (2), Plano Adiposo (2) y Vena Azygos (1). Ningún paciente presentó complicaciones clínicas. Además, la EVA preoperatoria media fue de 8 y la postoperatoria de 3, mientras que la ODI preoperatoria media fue de 56 y la postoperatoria de 30. Conclusión: La extravasación de PMMA fue frecuente en varias localizaciones y niveles, sin complicaciones clínicas. VP demostró ser eficaz para mejorar el dolor y la función. Nivel III; Estudio de cohorte retrospectivo longitudinal.

Lesión medular como complicación de la vertebroplastia y la cifoplastia / Spinal cord injury as a complication of vertebroplasty and kyphoplasty

La vertebroplastia y la cifoplastia son técnicas percutáneas mínimamente invasivas que se hallan indicadas en el tratamiento del dolor asociado con fracturas vertebrales osteoporóticas y tumorales. Aunque han demostrado ser técnicas seguras, pueden dar lugar a complicaciones derivadas de la llamada 'fuga de cemento'. Presentamos el caso clínico de dos mujeres con 37 y 62 años, quienes presentaron fracturas toracolumbares múltiples, la primera de etiología traumática y la segunda osteoporótica, con afectación de muro posterior. Tras implementarse dichas técnicas las pacientes presentaron lesión medular incompleta por escape de cemento al canal medular; en el segundo caso se produjo también embolismo pulmonar por cemento. A fin de solucionar dichas complicaciones, se realizaron sendas laminectomías con extracción del material y las pacientes ingresaron a tratamiento rehabilitador; en la paciente con embolismo se inició procedimiento de anticoagulación. Al alta, ambas presentaban mejoría exploratoria y realizaban marcha con ortesis. Se concluye que la vertebroplastia y la cifoplastia son técnicas relativamente seguras aunque no exentas de complicaciones, pues la fuga de cemento a los plexos venosos constituye una complicación conocida y reportada. Es importante una apropiada selección de pacientes, comprobando la integridad del muro posterior; así mismo, los pacientes deben ser evaluados cuidadosamente desde el punto de vista respiratorio.

Vertebroplasty and kyphoplasty are minimally invasive percutaneous techniques indicated for the treatment of pain associated with osteoporotic and tumor vertebral fractures. Although they have proven to be safe techniques, they can give rise to complications derived from the so-called 'cement leakage'. We present the clinical case of two women aged 37 and 62 years, who presented multiple thoracolumbar fractures, the first of traumatic etiology and the second osteoporotic, with posterior wall involvement. After implementing these techniques, the patients presented incomplete medullary lesion due to cement leakage into the medullary canal; in the second case there was also pulmonary embolism due to cement. In order to solve these complications, two laminectomies were performed with removal of the material and the patients were admitted for rehabilitation treatment; in the patient with embolism, anticoagulation procedure was started. At discharge, both patients showed exploratory improvement and were walking with orthosis. We conclude that vertebroplasty and kyphoplasty are relatively safe techniques, although they are not free of complications, since cement leakage to the venous plexus is a known and reported complication. Appropriate patient selection is important, checking the integrity of the posterior wall; likewise, patients should be carefully evaluated from the respiratory point of view.

Calidad de vida y balance sagital en la evolución de los pacientes con mieloma múltiple tratados con vertebroplastia percutánea / Quality of Life and Sagittal Balance in the Evolution of Patients with Multiple Myeloma Who Received Treatment

RESUMEN Introducción: El mieloma múltiple representa el 1 por ciento de las neoplasias y el 10 por ciento de las hemopatías malignas. La edad media de presentación es 65 años. El dolor óseo en columna vertebral y costillas constituye su manifestación inicial. El tratamiento quirúrgico del mieloma múltiple en la columna consiste en descompresión amplia y artrodesis. La vertebroplastia se considera técnica de elección porque restablece el balance sagital y coronal, contribuye al fortalecimiento del cuerpo vertebral, y disminuye el dolor asociado a fracturas. Objetivo: Evaluar el efecto de la vertebroplastia sobre la calidad de vida y el balance sagital, en la disminución del dolor. Métodos: Se estudiaron 192 pacientes con mieloma múltiple con fractura en la columna, 80 tratados con vertebroplastia y 112 en forma conservadora. Se utilizó el cuestionario de Oswestry y la escala de Karnosfky. Resultados: La vertebroplastia disminuyó 0,52 veces el uso de analgésicos opioides. Conclusiones: La vertebroplastia representa un mayor beneficio de la calidad de vida de los pacientes aquejados de mieloma múltiple con fractura vertebral; repercute en el mejoramiento del balance sagital, el nivel de discapacidad y la capacidad para realizar tareas cotidianas(AU)

ABSTRACT Introduction: Multiple myeloma accounts for 1 percent of neoplasms and for 10 percent of malignant hematomas. The mean onset age is 65 years. Bone pain in the spine and ribs is its initial manifestation. Surgical treatment for multiple myeloma in the spine consists in wide decompression and arthrodesis. Vertebroplasty is considered the choice technique because it restores sagittal and coronal balance, contributes to the strengthening of the vertebral body, and reduces pain associated with fractures. Objective: To assess the effect of vertebroplasty on quality of life and the effect of sagittal balance in reducing pain. Methods: 192 patients with multiple myeloma and spinal fracture were studied, 80 treated with vertebroplasty and 112 treated conservatively. The Oswestry questionnaire and the Karnofsky scale were used. Results: Vertebroplasty decreased the use of opioid analgesics by 0.52 times. Conclusions: Vertebroplasty represents a greater benefit for the quality of life of patients suffering from multiple myeloma with vertebral fracture. It affects the improvement of sagittal balance, the level of disability, and the ability to perform daily tasks(AU)

Fractura vertebral osteoporótica en el adulto mayor / Osteoporotic vertebral fracture in the elderly

La fractura osteoporótica es una entidad clínica que afecta seriamente la calidad y expectativa de vida del paciente, agregándose un impacto socioeconómico elevado, superando incluso a los gastos de patologías como el infarto agudo de miocardio, accidente cerebrovascular y cáncer de mama, y cuya incidencia y prevalencia va en aumento a medida que la población mundial envejece. La gran mayoría de los casos cursan inadvertidos y sub diagnosticados, dejando a tres de cuatro pacientes, sin tratamiento y expuestos a nuevos eventos. El foco mundial en los países desarrollados como estrategia de enfrentamiento de esta patología endémica ha sido el de la prevención, vale decir medicina primaria. Sin embargo, una vez diagnosticada la fractura osteoporótica, no existe consenso en el tipo de tratamiento óptimo, así como sus plazos en estos pacientes. La mayoría de las guías internacionales y los trabajos publicados, presentan diferencias en el manejo de esta lesión.

The osteoporotic fracture is a clinical entity that seriously affects the quality and life expectancy of the patient, adding a high socioeconomic impact, even exceeding the expenses of pathologies such as acute myocardial stroke, vascular cerebral stroke and breast cancer, and whose incidence and prevalence is increasing as the world population ages. The vast majority of cases are non-diagnosed, leaving three of four patients with non treatment at all. The target in developed countries as a strategy to confront this endemic pathology has been prevention, or, primary medicine. However, once the osteoporotic fracture is diagnosed, there is no consensus on the type of optimal treatment, as well as its deadlines in these patients. The majority of international guidelines and published articles show differences in the management and treatment of this fracture.

Fracturas vertebrales: evaluación, diagnóstico y tratamiento: Revisión del tema / Vertebral fractures: evaluation, diagnosis and treatment: Review

Las fracturas vertebrales son una de las fracturas más comunes relacionadas a la fragilidad ósea y son causa de morbilidad importante. Sin embargo la epidemiología de las fracturas vertebrales difiere de las fracturas osteoporóticas en otros sitios esqueléticos, ya que solo una tercera parte de las fracturas vertebrales son reconocidas clínicamente y detectadas al realizar una metodología de imagen apropiada, ya que un alto porcentaje presenta FV asintomáticas, las cuales no son detectadas hasta realizar una radiografía simple de columna dorso-lumbar. Por otro lado la identificación de una fractura vertebral como aguda o crónica, benigna o maligna, hace que el médico tratante presente diferentes estrategias terapéuticas. El objetivo de este artículo de revisión es dar al lector información sobre la epidemiología, los costos, los tipos de fracturas vertebrales, que ocurre con las fracturas vertebrales en las enfermedades reumatológicas, como realizar una evaluación radiográfica de las fracturas vertebrales, la identificación acorde a las diferentes metodologías por imagen, y como es el tratamiento adecuado de las mismas.

Vertebral fractures are one of the most common fractures associated with skeletal fragility and can cause as much morbidity. However, the epidemiology of vertebral fractures differs from that of osteoporotic fractures at other skeletal sites in important ways, largely because only one-third of vertebral fractures are recognized clinically at the time of their occurrence and they require lateral spine imaging to be recognized. In otherwise the identification of vertebral fractures as acute or chronic, benign or malignant, is important for the physician to apply the more appropriate treatment. The objective of this paper is review points as epidemiology, cost, types of vertebral fractures, what happens in rheumatological diseases, the importance of different imaging technique, and review the more appropriate treatment.

Outcomes of vertebroplasty in osteoporotic vertebral fractures with limited indication. / Resultados de la vertebroplastia en fracturas vertebrales osteoporóticas con indicación límite.

INTRODUCTION: Vertebroplasty has been shown to be effective for improving quality of life and pain of osteoporotic vertebral fractures (OVF) without neurological deficit and not susceptible to conservative treatment. It is advisable to perform them on recent fractures with 50% crush and without the involvement of the canal, although there are no standard recommendations. In some cases these limits are exceeded. We analyse the outcomes of percutaneous vertebroplasty (PVP) in OVF with relative/limit indication. MATERIALS AND METHODS: Retrospective analysis of 88 patients (126 fractures) who underwent surgery by PVP; 95/126 were osteoporotic fractures. Thirty-four cases (35%) were included in the relative indication group, with at least one of the following: canal involvement,>50% collapse, and>12 months of evolution of the fracture. The rest of the cases were included in the standard indication group. We performed clinical-radiological follow-up, collected intraoperative data on techniques and complications, occurrence of leaks, postoperative clinical improvement (according to VAS), new adjacent fractures, and satisfaction. RESULTS: Most fractures were between D11-L2 (66%) with 6-8 months follow-up. No significant differences were observed regarding clinical improvement in either group. A higher percentage of leaks were detected in the relative indication group, 44% in comparison to 29.5% in the standard indication group, without statistical significance. All leakages were asymptomatic. There were 3new OVF after PVP in the relative indication group and 4in the standard group, without statistically significant differences. DISCUSSION AND CONCLUSIONS: The use of cement in OVF with relative indication led to the same clinical benefit in our sample as those with standard indication. A higher number of leakages occurred in the relative indication group with no clinical consequences or adjacent fractures.

Vertebroplastia percutánea / Percutaneous vertebroplasty

La vertebroplastia percutánea es una técnica aplicable a pacientes con fractura vertebral con síndrome doloroso importante y que no mejora con un manejo ortopédico y clínico integral. Se incluye una apretada historia del procedimiento, y se revisan sus indicaciones y contraindicaciones, así como las publicaciones que analizan sus ventajas y riesgos (AU)

Percutaneous vertebroplasty is a technique for the treatment of patients with vertebral fracture who have persistent pain even after orthopedic and clinical therapeutic measures. A brief historical note of the procedure is presented, and its indications and contraindications are outlined, along with a literature overview of its advantages and risks (AU)

RADIOACTIVE CEMENT OF PMMA AND HAP-Sm-153, Ho-166, OR RE-188 FOR BONE METASTASIS TREATMENT / CIMENTO RADIOATIVO DE PMMA E HAP-Sm-153, Ho-166 OU RE-188 NO TRATAMENTO DE METÁSTASES ÓSSEAS

ABSTRACT Polymethylmetacrylte (PMMA) is used in the fields of dentistry and biomedicine as a constituent of bone cements. Hydroxyapatite (HAp) is a bioceramic produced naturally in the bones. PMMA and HAp are fundamental constituents in the preparation of bone cements. Bisphosphonates have also been used as radiopharmaceutical in dental implants and nuclear medicine, or as palliative systemic treatment for pain reduction in bone metastasis. Vertebroplasty and kyphoplasty are bone cement-based techniques used in orthopedics, being minimally invasive procedures with low risks of infections, applied in osteoporosis and high-impact fractures. Recently, Núcleo de Radiações Ionizantes da Universidade Federal de Minas Gerais proposed a synthetic composite of M-HAp with a metallic nuclide M. After irradiation, M-HAp was added to PMMA, compounding a radioactive bone cement that can recover bone body stabilization, pasting microfractures and recomposing the anatomy and functionality of the affected parts by the compression of bone metastases, with possible pain reduction through quick radiation-induced decompression. Computational dosimetric models, and the synthesis and characterization of bioceramics that incorporate Re-188, Ho-166, or Sm-153 have demonstrated the benefits of these biometrics as promising alternative therapies, mainly from their ability to maintain the ionization in the bone structure, thereby sparing the spinal cord. This article presents a review on this topic. Level of Evidence V, Expert Opinion.

RESUMO Polymethylmetacrylte (PMMA) é um composto utilizado na indústria e desde os anos 80's também tem sido empregado nas áreas odontológica e biomédica como constituinte de cimentos ósseos. A hydroxyapatite (HAp) é uma biocerâmica produzida naturalmente nos ossos. Esses dois componentes são constituintes fundamentais no preparo de cimentos ósseos. A síntese artificial de HAp pode ser feita pelo método sol-gel. Bifosfanatos tem também sido utilizado na odontologia em implantes dentários e na medicina nuclear, como radiofármaco ou no tratamento paliativo sistêmico de redução de dor das metástasis ósseas com 153 Sm-EDTPM. A Vertebroplastia e Cifoplastia são técnicas empregadas na ortopedia utilizando o cimento ósseo, sendo procedimentos minimamente invasivos de baixo risco de infeções, aplicadas em osteoporose e fraturas de alto impacto. Recentemente, no Grupo de Pesquisa NRI - Nucleo de Radiações Ionizantes/UFMG, foi proposto um compósito de M-HAp com nuclideo metálico M incorporado na matriz, que após ativado é adicionado ao PMMA constituíndo um cimento ósseo radioativo que pode recuperar a estabilização o corpo ósseo, colando microfraturas, recompondo a anatômia e funcionalidade de peças afetadas pela compressão das metástases ósseas com possível redução de dor pela rápida descompressão induzida pela radiação. Modelos dosimétricos computacionais, sintese e caracterização destas biocerâmicas incorporando Re-188, Ho-166 ou Sm-153 tem indicado benefícios radioterapêuticos promissores, podendo se tornar uma alternativa para radioterapias convencionais, principalmente por conter a dose absorvida na estrutura óssea, por exemplo no corpo da vertebra poupando a medula espinhal. O presente artigo apresenta uma revisão sobre o tema. Nível de Evidência V, Opinião do Especialista

Embolia pulmonar por metilmetacrilato / Pulmonary embolism due to methyl acrylate

Resumen La vertebroplastia es un procedimiento terapéutico que se usa para reparar lesiones vertebrales. Por su parte, el metilmetacrilato, es un cemento óseo que se inyecta en el hueso esponjoso del cuerpo vertebral durante dicho procedimiento. Se expone el caso de una paciente de sexo femenino de 59 años, con antecedente de artrodesis lumbar, quien consultó por lumbalgia tipo punzada, posterior a caída desde su propia altura. Al examen físico se refirió dolor en región torácica sin signos clínicos de radiculopatía e imposibilidad para la movilización. Los estudios imagenológicos reportaron fractura por acuñamiento de cuerpos vertebrales T12-L1. Se hizo cambio de material de artrodesis que requirió uso adicional de metilmetacrilato para fijación de tornillos canulados. Dos horas posteriores al procedimiento quirúrgico refirió dolor torácico, disnea y taquipnea por lo cual se solicitaron estudios adicionales. Por hallazgos en la radiografía de tórax, se sospechó embolia pulmonar secundaria a metilmetacrilato y por tanto se solicitó tomografía computarizada de tórax. Fue trasladada a la unidad de cuidados intensivos; luego de 72 horas de estancia allí, se hizo ecocardiograma que mostró cavidades derechas dilatadas, hipoquinesia del ventrículo derecho con deterioro de la sístole, insuficiencia tricúspide e hipertensión pulmonar moderada. Se indicó tromboprofilaxis por tres meses y seguimiento por servicios de Medicina interna y Neurocirugía.

Abstract Vertebroplasty is a therapeutic procedure that is used to repair spinal lesions. For its part, methyl acrylate is a bone cement that is injected into the spongy bone of the vertebral body during this procedure. The case is presented of a 59 year-old woman with a history of a lumbar arthrodesis, who consulted due stabbing-type lower back pain, after a fall from her own height. On physical examination, she had pain in the thoracic region with no clinical signs of radiculopathy, and impossibility for movement. The imaging studies reported a fracture due to wedging of vertebral bodies T12-L1. A change was made in the arthrodesis material, which required the additional use of methyl acrylate to fix the cannulated screws. Two hours after the surgical procedure, she referred to chest pain, dyspnoea and tachypnoea, for which further studies were requested. Due to the findings in the chest x-ray, a pulmonary embolism induced by methyl acrylate was suspected, for which a computed tomography scan of the chest was requested. She was transferred to the Intensive Care Unit. After 72 hours of admission there, an echocardiogram was performed that showed dilated right cavities, hypokinesis of the right ventricle with systolic dysfunction, tricuspid insufficiency, and moderate pulmonary hypertension. Thromboprophylaxis was prescribed for three months and follow-up by the Internal Medicine and Neurosurgery departments.