What is a Vertebroplasty?
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
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
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
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
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?
What are the risks of the procedure?
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.
1) Leakage of
cement into veins and or lungs
4) Rib or Pedicle fracture
6) Worsened pain
7) Paralysis secondary to leakage of cement
Is it a long procedure?
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
2) Painful compression fracture secondary to
tumor which does not respond to conventional
3) Prevent further compression fractures
4) Buttress weakened bone for spine fusions
1) Young patient - the
long term effects of the cement mixture are
2) Vertebral bodies above the T5 level - the
procedure is riskier and more difficult
3) Patients with prior unsuccessful spine
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
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