Spinal Pains in Geriatric Group of Osteoporotic Vertebral Body Compression-fracture Relieved with Cath Lab-Vertebroplasty using Small-Volume Glass Acrylate

Abstract: Generalized osteoporosis and "osteoporotic vertebral body compression fractures" (OVBCF) are interrelated geriatric problems. Spinal pains of OVBCF and osteoporosis both are resistant to medicinal treatments. Surgical and C-arm Vertebroplasty are time consuming and difficult-operations. It can cause severe neurological deficits adding more debility to geriatric patients. Percutaneous minimal invasive procedure using glass acrylate (PMMA) and 'digital subtraction angiography Catheterization laboratory unit' (Cath lab PVP) can be combined effectively for augmenting pain relief. With Cath lab PVP no more problems related to acrylate viscosity and injection are noticed. Acrylate exudation in intra-dural and intra-neural spaces can easily be averted.

Objective: is to 1) Evaluate small volume PMMA in providing stability, safety and efficacy to OVBCF. 2) Effectiveness of Cath lab in reducing PMMA viscous to small volume, in relieving pains related to acute OVBCF pains. 3) To use minimal invasive and small procedural time in geriatric patient.

Material method: Cath-lab is a multi-directional fluoroscopic high resolution digital subtraction angiographic imaging unit. Augmentation procedure performed in Cath lab is called as "Cath lab-Vertebroplasty (Cath lab-PVP). Twenty two OVBCF treated with Cath lab- PVP. Small volume, defined less than 3ML of viscous acrylates. It is injected through trans-pedicular route.

Results: Small volume fluid acrylate is well spread within the fractured crevices. Molded vertical cast between cortical plates maintains vertical body strength very effectively. Cath lab speed procedure too becomes effective.

Conclusion: Significant (90%) pain relief achieved within 24 to 48 hours in eighteen (81.81%) patients. Cath lab-PVP increases safety, early mobility without analgesics. Small volume PMMA is optimal and less prone for complication. Cath lab PVP fluoroscopy with its increased PMMA radio opacity monitors bone filling well. It has less procedural time and better psychological impact on the minds of geriatric.