Percutaneous vertebroplasty in the treatment of malignant spine disease

Percutaneous vertebroplasty is a minimally invasive, radiologically-guided inter ventional procedure originally developed in France for the treatment of painful ver tebral hemangiomas. The technique consists of the percutaneous puncture of the affected ver tebral body, followed by injection of an acrylic polymer to provide bone augmentation and prevent fur ther collapse. The internal "casting" of the trabecular microfractures results in pain relief and ver tebral consolidation. Vertebroplasty was quickly adopted for use in metastatic ver tebral lesions and hematologic malignancies such as multiple myeloma and lymphoma. The major experience with malignant disease has remained primarily in the European realm; in the United States ver tebroplasty is used mainly for the treatment of osteoporotic compression fractures. The reasons underlying this divergence in practice experiences remains unclear, although the explosion of vertebroplasty in the U.S. appears to be driven by an assertive, motivated and well-informed elderly population. In addition, malignant lesions are often challenging and practitioners may shy away from these clinically and technically more difficult patients. The purpose of this article is to introduce the principles of percutaneous ver tebroplasty to the Nor th American oncologic community with the hope that itmay find agreater role in the treatment of malignant disease affecting the spine.