**Question:** Percutaneous vertebroplasty is indicated in all except -

A. Patients with a bleeding disorder
B. Patients with severe osteoporosis and imminent collapse of the involved vertebrae
C. Patients with spinal infections
D. Patients with spinal tumors causing spinal compression

**Core Concept:**
Percutaneous vertebroplasty is a minimally invasive procedure used to relieve pain caused by osteoporotic or pathologic vertebral compression fractures. It involves injecting a mixture of bone cement (polymethyl methacrylate) and contrast medium into the fractured vertebral body to stabilize it and reduce pain.

**Why the Correct Answer is Right:**
The correct answer is **A. Patients with a bleeding disorder**. Percutaneous vertebroplasty is contraindicated in patients with a bleeding disorder, as the procedure involves a significant risk of blood vessel and nerve injury due to the manipulation of the needle and catheter. In patients with a bleeding disorder, such as von Willebrand's disease or hemophilia, the procedure could lead to increased bleeding and complications.

**Why Each Wrong Option is Incorrect:**

**B. Patients with severe osteoporosis and imminent collapse of the involved vertebrae:**
Percutaneous vertebroplasty is generally indicated in patients with severe osteoporosis and imminent collapse of the involved vertebrae, as it can stabilize the fractured vertebrae and reduce pain effectively.

**C. Patients with spinal infections:**
Percutaneous vertebroplasty is not indicated in patients with spinal infections, as the procedure could worsen the infection and lead to further complications. Infected vertebral bodies should be treated with antibiotics and debridement, if necessary, before considering vertebroplasty.

**D. Patients with spinal tumors causing spinal compression:**
Percutaneous vertebroplasty is not indicated in patients with spinal tumors causing spinal compression, as the procedure does not address the underlying pathophysiology of the tumor-induced vertebral compression. Instead, the treatment of choice for spinal tumors is surgical intervention, such as decompression and tumor excision. Vertebroplasty is indicated in patients with osteoporotic vertebral compression fractures and severe pain.

**Correct Answer Explanation:**
The correct answer is **C. Patients with spinal infections**. Vertebroplasty is not indicated in patients with spinal infections as it could worsen the infection and lead to further complications. Infected vertebral bodies should be treated with antibiotics and debridement, if necessary, before considering vertebroplasty. Infections can be a source of ongoing inflammation and sepsis, which could exacerbate the vertebral body collapse and cause further damage to the spinal cord or nerve roots. Additionally, the procedure could introduce bacterial contamination to the infected vertebral body, worsening the infection.

**Core Concept:**
The primary indication for percutaneous vertebroplasty is to treat osteoporotic vertebral compression fractures causing severe pain. In such cases, the procedure can stabilize the fractured vertebrae and alleviate pain by filling the vertebral body with bone cement, preventing further collapse and reducing the risk of neurological complications like spinal cord or nerve root compression.

**Why Wrong Options are