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What is a Vertebroplasty?
The spine is made up of bones called vertebrae that are linked together. When these bones become weakened , one or more can break and start to flatten out. This is known as a compression fracture. There are many causes for weak bone. The most common is Osteoporosis, where the bone becomes soft from loss of calcium. When osteoporosis becomes severe, the vertebrae can break very easily. Something as simple as a sneeze can cause a fracture. Most fractures heal with time, but some do not heal well. The fractures may continue to be a source of pain and make the activities of daily living like walking or using the bathroom difficult. Vertebroplasty was developed to help these people. Bone cement is injected into the vertebrae to strengthen it and also to decrease the pain.

What do I need to do before the Procedure?
You will need to consult with your doctor to see if you are a candidate for vertebroplasty. You will also need some tests to identify which vertebrae are affected and whether the procedure can be performed safely and with a high degree of success. These tests include x-rays, an MRI scan, and sometimes a CAT scan. If you are a candidate for the procedure, you will have some blood tests done to avoid problems with bleeding. The night before the procedure, starting at midnight, do not eat or drink anything.

Take your usual medicines on the day of the procedure. Call your doctor if you take insulin shots. Your doctor may change the insulin dose for the day of the procedure. Do not take any pain medicine for at least 4 hours before the procedure. The anesthesiologist will give you medication to help you relax and feel comfortable during the procedure.

What happens during the procedure?
The vertebroplasty is performed in a special x-ray room in the Radiology department (x-ray department) by trained radiologists and technologists. During the procedure, you will lie face down on a table that can be moved in all directions. Above the table is a fluoroscope that uses x-rays so that the radiologist can "see" what he is doing. The anesthesiologist or radiologist will give medication that will make you sleepy and relax you. The technologist will thoroughly clean the skin over the back. Everyone in the room will be wearing a cap and mask for your protection. The radiologist will find the broken vertebra and numb the area with a medication that may sting when injected. Once the area is numb, the radiologist will place needles into the broken vertebra using x-rays to guide him. You may feel pressure on your back. Contrast media (x-ray dye) is then injected into the vertebra through the needles to make sure they are in good position. When good needle position is confirmed, cement is then injected until the vertebra has been filled. The cement does two things. First, it stabilizes the fracture. Second, the cement gets hot as it hardens; this heat is thought to destroy the pain producing nerve endings in the vertebra. The needles are then removed and the small needle holes are bandaged.

What can I expect after the procedure?
You will be taken to the recovery room and will stay in bed for 4 hours to let the bone cement fully harden. During this time you can ask for pain medication if needed. Usually, you will go home the same day and receive a prescription for pain medication. Remember that this is a surgical procedure and you will likely have some wound pain that will subside in four to seven days. The wounds should be kept clean and dry for at least five days. You will receive written instructions to follow at home.

What are the Risks?
Any invasive procedure may have complications. The radiologist will discuss possible complications with you before the procedure.

One possible complication is allergy to the medicines or the contrast media. The contrast media has an iodine base. Tell your nurse or physician if you have had a reaction to other x-ray dyes, iodine or any medications.

Cement is injected into the vertebra during the procedure. Sometimes, the cement can leak outside the vertebra and press on nerve roots or the spinal cord. In addition, it can migrate to the lung. If these things happen, cement injection is stopped immediately and usually there are no problems; however, in a small percentage of cases these adverse events can lead to worsened pain, paralysis, or require surgery to remove the cement.

Any procedure that breaks the skin can result in bleeding or infection.

Is vertebroplasty for everyone?
No. Vertebroplasty is intended to treat the pain of compression fractures. Old fractures that are no longer painful would not benefit from vertebroplasty. This procedure is NOT intended for those patients who suffer from the pain associated with degenerative disc disease or degenerative joint disease of the spine.

What does the procedure involve?
In vertebroplasty, an acrylic "bone cement" is injected through a needle into the collapsed vertebral body of the spine to reinforce the bone. About 10 minutes later, the cement solidifies and actually becomes harder than the native bone. The crushed bone fragments are fused together and no longer abrade against nerve endings when you move. That's what alleviates your pain.

Is vertebroplasty risky?
As with any medical procedure, there are risks. But with vertebroplasty, the risks are minor and happen rarely, on average less than 2% of cases. There are no reported cases of hemorrhage or infection as a result of vertebroplasty.

What are the risks of the procedure?

1) Leakage of cement into veins and or lungs
2) Infection
3) Bleeding
4) Rib or Pedicle fracture
5) Pneumothorax
6) Worsened pain
7) Paralysis secondary to leakage of cement

 

Is it a long procedure?

The vertebroplasty procedure, in most cases, is done on an out-patient basis. It takes less than an hour per vertebral body treated and patients usually go home the same day.

What are indications for Vertebroplasty?
1) Painful compression fracture secondary to osteoporosis
2) Painful compression fracture secondary to tumor which does not respond to conventional therapy
3) Prevent further compression fractures
4) Buttress weakened bone for spine fusions

Relative Contraindications
1) Young patient - the long term effects of the cement mixture are unknown
2) Vertebral bodies above the T5 level - the procedure is riskier and more difficult
3) Patients with prior unsuccessful spine surgery

Patient Evaluation
1) History and Physical Examination
2) Current x-rays
3) MRI +/- bone scan

Follow Up Care
1) Pain medications - usually tapered over several days after procedure
2) Muscle relaxants
3) Adjust medications to prevent further mineral loss

Vertebroplasty Statistics
1) >80% moderate to marked pain relief
2) <5% induced fractures from procedure
3) <1% symptomatic embolism or infection

  FDA Warns About Possible Complications of Cement Used to Treat Spinal Fractures