Vertebroplasty is a relatively new procedure designed to treat local pain originating from a compression fracture in a vertebral body, usually secondary to osteoporosis (diminished bone density).
The procedure is performed using x-ray guidance to accurately place medical grade cement into a partially compressed vertebral body (Fig.1). This cement-like material is injected in liquid form through a needle placed through the skin and into the vertebral body.
This procedure has been very successful in relieving pain associated with vertebral collapse in appropriately selected patients with success rates on the order of 85-90%. In most of the patients we have treated at the University Hospital of North Tees, the vertebral body collapse has been the result of osteoporosis, a process where bone mineral density loss is due to various medical conditions, aging, or the use of bone wasting medicines.
This procedure treats only the fractured vertebra and does not reverse the process of osteoporosis or prevent future compression fractures at other levels. This treatment should not be utilized nor expected to be effective to relieve compression of the spinal cord or its associated nerve roots.
Also, vertebral bodies must still retain a portion of their original height if successful injection of the medical cement is to be achieved. Therefore, the vertebral body needs to be treated before complete collapse occurs.
Standard x-rays of the spine are used to identify a collapsed vertebral body. An MRI (Fig. 2) or bone scan may be needed to determine which fracture is most recent or will be most amenable to therapy.
Treatment of the appropriate fracture is also determined by-careful physical examination to determine the site/level of pain.
A neurologic exam should show that there is only local pain associated with the vertebral collapse.
There should not be pain in other areas, or radiation of pain that would suggest nerve compression.
If all of these criteria are met, then there is a very good chance that percutaneous vertebroplasty will be successful at reinforcing the fractured bone and alleviating pain.
People who suffer from painful compression fractures of the spine related to loss of bone mineral (osteoporosis) and other causes may find relief with a new procedure being offered by the Spinal Service at the University Hospital of North Tees.
Osteoporosis, or brittle bones, affects 10 million people in the United States and each year leads to 700,000 painful spinal vertebral compression fractures (collapse of the weakened bone). Although in some people the fracture stabilizes on its own and the pain goes away, in others pain persists, most likely because the crushed bone doesn’t fully heal and continues to move. Surgery is frequently not an option, because the screws and hardware typically used in spine surgery will not hold in the brittle bone.
A new technique called percutaneous vertebroplasty (ver-TEE-bro-plasty), offers hope to people who previously have had few options other than spinal bracing and narcotics and other painkillers. The procedure involves injecting bone cement into the vertebra where a compression fracture exists, stabilizing the fracture and relieving the pain.
Prior to the procedure, radiologists use X-rays, magnetic resonance imaging (MRI) and bone scans to find the fracture or fractures that are causing the pain, and to rule out other causes of pain that may not be treatable with this technique. When the area is located and confirmed, a spine surgeon injects bone cement into the vertebra under X-ray guidance using a hollow needle. The procedure takes one to two hours and typically is performed with local anesthesia or general anestheisa.
During the procedure you will lie on your tummy on the operating table, and x-ray guidance is used to place the needle in to the vertebral body. The bone cement hardens within 15 minutes and the patient remains at bed rest for one to several hours. The outcome of the procedure in patients has been very encouraging, with the majority of patients experiencing partial or complete pain relief.
This minimally invasive treatment can give people back their mobility, and increase the quality of life. The cement makes the vertebral body stronger, possibly even stronger than normal bone, and can prevent further collapse. The procedure generally does not, however, return the vertebrae to its former size.
Frequently Asked Questions
What is a vertebroplasty?
It is a procedure that allows the doctor to inject a glue-like material, through a needle, into and around the vertebrae. The glue holds your vertebrae together. This will help take the pain away in your back and prevent damage to your spine.
What are the alternatives to a vertebroplasty?
Using medicine to control the pain. Surgical repair of the vertebra.
What can I expect before the vertebroplasty?
- You will be seen by one of our doctors and/or nurse clinicians, who will obtain a health history, perform a brief physical exam, explain the procedure, and answer your questions.
- You will have blood drawn and an IV (intravenous catheter) started.
- You will have x-rays and an MRI (magnetic resonance image) exam of your spine.
- You will sign a consent form.
Who will perform the vertebroplasty?
One of the surgeons in the spinal team, who have been specially trained in the technique.
How long will my hospital stay be?
Patients typically stay in overnight . You will be walking soon after the procedure.
Is the procedure safe?
Vertebroplasty is very safe, although as with any prodecure, care must be taken to avoid complications. The injection technique has been successfully used for a number of years to treat osteoporotic spinal fractures and other conditions leading to fractures of the spine.
For example, it has been used to treat fractures associated with vertebral tumor and blood vessel abnormalities. The bone cement used to stabilize the fractured vertebrae has been shown to be safe through many years of use in joint replacement surgeries and other orthopaedic procedures, although it is slightly modified for this procedure to allow visualization on X-ray.
Who is a candidate for vertebroplasty?
People who have suffered recent compressing fractures that are causing them moderate to severe back pain are the best candidates for vertebroplasty. In some cases, older fractures may be treated successfully, but the procedure is most successful if it is performed within a few weeks to several months after the fracture occurs. The procedure is not used to treat chronic back pain due to other causes, such as arthritis and herniated disks.
How successful is vertebroplasty?
Studies have shown that from 75 percent to 90 percent of people treated with vertebroplasty will have complete or significant reduction of their pain.
What are the risks or complications?
Vertebroplasty is a very safe procedure with few risks or complications. In many studies, no complications were reported. As with any medical procedure, the possibility of complications will depend on the individual patient. For example, patients with tumors in the spine or with other serious medical conditions may be at higher risk for complications from vertebroplasty.
In a small minority of patients the cement can leak into the lungs and cause some breathing difficulties, or into the spinal canal and press on the nerves or spinal cord, causing some weakness in the legs. This quite uncommon, and you may rarely need a second operation to decompress the nerves if this happens. Unusually also, the needle may result in some air going into the chest cavity, and a second procedure may be needed to sort this out.
The vast majority of patients however , have no problems with this procedure.
Will vertebroplasty treat or prevent loss of height or “widow’s hump”?
After a vertebra has fractured, there is typically a loss of only 20 percent to 30 percent of the height of the bone. But over several weeks, fractures may reoccur and the vertebra flattens out, until eventually there can be a 70 percent to 90 percent loss of height in the bone. Gradually, the back hunches over and the person loses height, especially if several vertebrae are involved. Vertebroplasty cannot reverse this loss of height or kyphosis (often called “widow’s hump) in individuals who already have these conditions.
Some studies suggest that treatment of spinal compression fractures with vertebroplasty can strengthen the spine and improve posture, which may help prevent further fractures that lead to height loss or kyphosis. Currently, however, there is no evidence to prove that the procedure will prevent these problems. However, new research on the horizon is looking at ways to solve these problems.
It should also be remembered that Vertebroplasty does not treat the underlying bone loss (osteoporosis) that can lead to vertebral fracture, and this should be considered also in the overall treatment plan. You will be seen by our osteoporosis nurse who works with our local Consultant Rheumatologist, and started on drugs to reduce the risk of further fractures. You may also need to have a special scan whichmeasures how much osteoporosis you have.
Preparing for Vertebroplasty
Remember to tell the doctor if you are on any blood thinning drugs (warfarin, heparin etc). The hospital stay will be usually 24 or 48 hours, so make sure you have your discharge arrangements sorted out prior to admission. You may need to have someone at home with you for a few days after the procedure, or arrange to go and stay with someone you know for a few days.