Surgically controlled, transpedicular methyl methacrylate vertebroplasty with fluoroscopic guidance.

The authors report a series of 13 patients with osteoporotic vertebral fractures treated by transpedicular vertebroplasty. Because of a neurological complication due to posterior leakage of acrylic cement the classical percutaneous approach was converted to an open surgical procedure. The latter allows direct visual control of neural structures and immediate removal of spilled cement, thus eliminating the danger of compressive, chemical and thermal effects of methyl methacrylate on neural elements. By use of this elegant technique primary stability of fractured vertebras is obtained leading to prompt pain relief in all patients. Surgically controlled vertebroplasty can be used in conjunction with internal fixation. By having studied the different ways of cement escape in their patients, the authors are convinced that surgically controlled vertebroplasty is safer than percutaneous vertebroplasty.