Vertebroplasty
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What Is Vertebroplasty?
Vertebroplasty, or percutaneous vertebroplasty, is a minimally invasive procedure for vertebral compression fractures (VCF) . The spinal compression fractures are small vertebrae breaks that may lead to the spine collapsing, which causes the spine to curve over. Osteoporosis is the most common cause of spinal compression fractures, followed by injuries.
Vertebroplasty strengthens and stabilizes the fractured vertebrae, returning the spine to its normal alignment. A spinal compression can be painful because the broken pieces of bones in the spine may rub together, irritating nerves and causing pain. A significant benefit of vertebroplasty is pain relief. Spinal re-alignment and pain relief can restore mobility.
Causes of vertebral compression include:
- osteoporosis
- trauma
- steroid use
- multiple myeloma
- haemangioma
Over the last twenty years, this innovative technique to augment the vertebral bodies and minimize pain has been developed as a treatment option for refractory VCFs.
Both vertebroplasty and kyphoplasty are procedures that involve the injection of medical cement into the fracture. This injection decreases pain and restores some height to the compressed bone. The results are usually quick and long-lasting.
Vertebroplasty procedure involves only external reduction. This reduction is reached out by extension of the patient when placing him on the operating table before the material is injected into the fracture site.
How Does Vertebroplasty Work?
Vertebroplasty is performed under live fluoroscopic guidance to ensure the accuracy and safety of this procedure. The procedure is performed in our pain clinics. During the procedure, the pain doctor of our clinic,
Dr. Majid Ghauri injects spinal cement through a needle into the fractured vertebrae to restore their strength and prevent them from collapsing again. The most commonly used bone cement is polymethylmethacrylate. This specially developed cement quickly hardens and stabilizes the fractured vertebrae, restoring the spine’s natural curvature.
Before Surgery
Before the day of surgery, the surgeon will perform a physical exam and take an x-ray or use an MRI or CAT Scan to pinpoint the exact location of the fractured vertebra. You will get instructions that may include the following.
- The medications to stop taking, like blood thinners
- Take surgeon-prescribed medications, if any
- Stop drinking and eating several hours before the procedure
- Stop smoking
- Wear comfortable clothing
- Do not wear jewelry
On the Day of the Surgery
The vertebroplasty procedure is an outpatient procedure. After changing into a clinic gown, the patient lays on the stomach on a treatment room table. An anesthesiologist administers a mild sedative or general anesthesia.
Once sedated or anesthetized, the surgeon uses fluoroscopic X-ray equipment to guide a needle into the damaged vertebra. Using the needle, surgical cement is injected directly into the fracture. The cement rapidly hardens, usually within 20 minutes, to create a stronger bone.
Once the cement is injected, the needle is removed and the puncture site is bandaged. Patients will remain at the clinic or hospital for 1-2 hours until medical personnel are sure there are no complications related to the sedative, anesthetic or procedure.
After Surgery
After surgery, the patient is asked to lay still for up to six hours. Most people can go home on the same day of the surgery, but there are situations where the patient stays overnight in the medical facility for observation—for example, someone frail or with a medical condition needing monitoring. Once released, someone needs to drive the patient home. The instructions post-surgery for home care usually include:
- Keep in place the bandage over the puncture wound for two days
- Rest for 24 hours and apply ice packs to manage discomfort at the puncture site
- Avoid strenuous activity and lifting heavy items for several weeks
- Avoid pushing, pulling and stretching movements for several weeks
- Take surgeon-recommended over-the-counter pain medication for up to two days as necessary
Patients may be advised to not drive for up to two weeks. Before leaving the medical facility, a follow-up appointment is set with the surgeon for three weeks after the procedure.
What is the Recovery Time After Vertebroplasty?
Any soreness experienced usually goes away within a few days. It may take approximately three weeks to recover fully. Some patients may be advised to wear a brace or go to physical therapy while healing.
Risks and Side Effects
As any other procedure or medication, there are potential risks of infection, bleeding, allergic reaction, and continued increases in pain, however, these risks are very low. Dr. Majid Ghauri uses continued x-ray guidance and sterile techniques throughout the procedure to reduce these risks.
Who is not a candidate for vertebroplasty?
Some patients are not considered good candidates for vertebroplasty. They may have:
- Old fracture
- Certain medical conditions
- Significant spinal canal narrowing
- Ongoing systemic infection
- Allergy to the surgical cement used
- Osteomyelitis (swelling) of the vertebra targeted
- Fractures that compromise the spinal canal and lead to myelopathy (severe compression) or radiculopathy (pinched nerve causing pain, weakness, numbness, etc.)
Though the vertebroplasty procedure has minimal risks, the surgeon must determine if an alternative approach is indicated if any risks are elevated due to the patient’s health condition.
How do I know if vertebroplasty will help my pain?
If a patient experiences a compression fracture and severe pain that does not respond to conservative treatments, vertebroplasty can help reduce or eliminate the pain. Conservative treatments include pain medications, rest or physical therapy. Approximately 87% of people who undergo vertebroplasty have experienced pain relief.
How long is the procedure?
The vertebroplasty procedure usually takes an hour, especially if only one vertebra needs treatment. However, the procedure may take longer if more than one spinal bone is involved.