الفهرس 
Introduction
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Abstract
Vertebral compression fractures occure as a result of failure of the anterior column by forward flexion forces. They rarely are associated with neurological deficit, except when multiple adjacent vertebral levels are affected. Medical management is the mainstay of treatment for these acute, painful compression fractures and includes bed rest, analgesics, braces, and physical therapy. In general, the acute pain resolves in 4 weeks to 8 months, but a spinal deformity may be the end results. Many of these fractures are the result of osteoporosis and relatively minor trauma. It appears that many of these fractures are not painful; however, they seem to be associated in certain instances with an impaired quality of life, increased mortality, and a significant morbidity (McAfee, 1985). In a recent review of the clinical consequences of vertebral compression fractures,it was shown that with each successive fracture, pulmonary force vital capacity was reduced by an average of 9%. Patients with vertebral compression fractures are at a 23% increased risk of mortality compared to agematched controls. Surgical treatment for symptomatic vertebral compression fractures has consisted in the past of reduction and internal fixation using an open anterior or posterior approach. Results have often been compromised because of osteoporosis, resulting in poor implant fixation (Silverman, 1992). As minimally invasive spinal surgery techniques have evolved, acutely painful vertebral compression fractures can be treated with a percutaneous procedure termed vertebroplasty. This procedure entails pacing large spinal needles into the fractured vertebral body through a channel made in the pedicle and injecting bone cement into the fractured bone. Vertebroplasty requires highpressure injection because of the structure of the trabeculae and the high viscosity of the bone cement as it hardens. This procedure was designed to decrease pain and strengthen the bone to prevent further collapse and to restore vertebral body height and prevent spinal deformity. Deramond reported that vertebroplasty reduced pain in 70% to 90% of patients; Chiras reported a major complication rate of 3.5% (Singer, 1995). To date percutaneous vertebroplasty has provided pain relief related to vertebral compression fracture with a very low complication rate. It?s believed that it will continue to gain scientific and patient acceptance and that it may ultimately become the standard of care for the treatment of painful vertebral compression. The use of percutaneous injection of cement to mechanically augment the skeleton may expand considerably beyond its currently limited applications in the spine after vertebral compression fracture. Percutaneous vertebroplasty stabilizes and strengthens the vertebral body and restore the height and shape of a compressed or wedged vertebra. A modification of the vertebroplasty procedure, termed kyphoplasty, is being evaluated. Kyphoplasty involves the inflation of a highpressure balloon that is introduced through an 11gauge needle into the vertebral centrum to restore the height and shape of the vertebral body. The resultant cavity is then filled with cement. In addition, vertebroplasty has been effective when used in conjunction with radiation to treat tumours and cancer of the bone. Percutaneous vertebroplasty may also benefit heart and lungtransplant patients who have experienced compression fractures following the use of oral steroids as part of an immunosuppressive regimen or chronic condition. Although the success of vertebroplasty is usually attributed to the support and reinforcement of the bone provided by the hardened cementlike substance. It is also likely that the heat created by the substance immediately after it is administered could play a part in the pain relief. But it may also be that the heat generated by the hardening process kills nerve ends that are causing the pain, and this is especially possible since pain relief can be evident immediately after the procedure. Thus percutaneous vertebroplasty is considered as effective minimalinvasive technique for the treatment of painful vertebral compression fractures caused by osteoporosis and malignancy. It may allow for faster return of function, and thus avoid the morbidity associated with medical treatment. It is extremely important to distinguish the pain caused by vertebral compression fracture from other numerous causes of back pain when selecting patients for this procedure. This procedure is a valuable new tool that will be more commonly used in the future to treat bone pain.