Cementoplasty for Spinal Fractures
Yes, cementoplasty (percutaneous polymethylmethacrylate/PMMA injection) is definitively used to treat painful spinal fractures, particularly when conservative medical management fails after 6 weeks or when pain prevents ambulation despite appropriate analgesia. 1
Primary Indications
Vertebral augmentation with PMMA cement is indicated for:
- Symptomatic osteoporotic vertebral compression fractures refractory to medical therapy 1
- Painful pathologic fractures from spinal metastases 2
- Cancer-related vertebral compression fractures 1
The procedure provides both rapid pain relief and structural reinforcement more quickly than other treatment measures 2.
When to Proceed with Cementoplasty
Failure of medical therapy is defined as: 1
- Back pain persisting at a level that prevents ambulation or physical therapy despite appropriate analgesic therapy
- Significant side effects from analgesia (confusion, sedation, severe constipation) at doses required for pain control
- Minimum 6 weeks of conservative medical therapy attempted
Point tenderness at the spinous process of the fractured vertebra on physical examination is the classic finding that confirms the painful level 1.
Absolute Contraindications
Do not perform cementoplasty if: 1
- Active systemic or spinal infection present
- Uncorrectable bleeding diathesis exists
- Patient cannot safely tolerate sedation or general anesthesia due to cardiopulmonary compromise
- Known allergy to PMMA polymer
Relative Contraindications
Exercise caution with: 1
- Significant spinal canal stenosis or compressive myelopathy from retropulsed fracture fragments or epidural tumor extension
- Radiculopathy exceeding local vertebral pain
Clinical Effectiveness
The evidence demonstrates substantial benefit. In a large retrospective series of 97 patients undergoing 258 vertebroplasty procedures, 74% reported significant quality of life enhancement, with 63% reducing narcotic use and 51% improving ambulation 3. Importantly, no patient reported worsening after the procedure 3.
For pathologic fractures from metastases, vertebral augmentation is safe and effective, particularly when combined with thermal ablation procedures for radiation-resistant tumors 2.
Critical Imaging Requirements
MRI must be performed on all patients unless contraindicated 1. This single test:
- Distinguishes benign osteoporotic from pathological fractures
- Identifies the unhealed fracture level (hyperintense signal on STIR or fat-saturated T2 sequences indicates bone marrow edema)
- Detects other acute fractures not visible on plain radiography
- Assesses for epidural tumor extension or spinal cord compression
Common Pitfall
If clear disparity exists between physical examination findings and imaging, or if an alternative source of back pain is evident, do not perform vertebral augmentation 1. In patients with multiple compression fractures, precise localization of the acute painful fracture is essential to maximize treatment response—consider physical examination under fluoroscopic guidance for difficult cases 1.
Technical Considerations
The procedure requires high-quality biplane fluoroscopy, particularly during cement delivery, with rapid availability of CT/MRI for any clinical deterioration 1. Cement leakage occurs but is typically asymptomatic, with rates around 15-20% including venous, paravertebral, and intradiscal leakage 4.