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What is Vertebroplasty?

The spinal column is composed of multiple bones called vertebrae. Fractures, or compressions of the vertebrae may occur. Vertebroplasty is a new procedure being used to help many people with painful bone fractures that involve the spine. The term “vertebro” means vertebrae and the term “plasty” means to form. Hence the vertebroplasty procedure forms integrated support for the fractured vertebrae. Vertebroplasty involves injecting medical cement into the fragile fracture site. It will harden and permanently stabilize the fracture, thereby improving or relieving back pain. Most patients treated will have complete or significant reduction of their pain with vertebroplasty. The procedure is generally safe, with few risks. The potential complications and risks of the procedure should be discussed with your coctor.

Are you the correct patient for a vertebroplasty procedure?

Both men and women may be affected by osteoporosis, or thinning and fragility of the bones. Postmenopausal women are at a greater risk of developing this disease. As we age there is a loss of bone density. At some point, the bone is not strong enough to support itself and the bone collapses. This is called a compression fracture. These may heal over time, but sometimes they do not. Meanwhile, the period of time when one is waiting for healing can be so debilitating that other illnesses can develop while one is immobile and/or bedridden. Affected individuals can benefit from vertebroplasty and may return to a more normal lifestyle.

Persons affected typically complain of a sudden onset of back pain that is localized to one spot. The pain can radiate to the front; however, leg symptoms/sciatica may occur. Other, less frequent, indications for this type of procedure include compression fractures due to: long-term steroid use, benign blood vessel expansions, or tumors. We can usually relieve such pain associated with compression fractures by vertebroplasty.

The treatment of compression fractures requires the interaction of multiple medical disciplines. Your Family Physician or Internist will evaluate you medically for conditions that might predispose to osteoporosis, and prescribe proper medications to prevent further bone loss if necessary. A Spine Surgeon may evaluate your condition to determine if other forms of spine stabilization may be required. It is the Interventional Neuroradiologist who reviews the xrays, CT scans, or MR images that may have been performed, and performs the procedure only after all of the physicians involved in your care agree you are a candidate.

Vertebroplasty
The Spine

The spine is a flexible column formed by a series of bones called vertebrae, each stacked one upon another to support the head and trunk. The spine is made up of 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused into one), and 4 coccygeal (fused into one). The vertebrae most commonly affected by compression fractures are one or more of the thoracic or lumbar vertebrae.

The intervertebral discs are located between the vertebrae from the second cervical vertebrae to the sacrum. They vary in size, thickness, and shape at different levels of the spine. The purpose of the intervertebral discs is to cushion movement.

The spinal cord is a slender nerve column that is protected within the spine. It passes downward and terminates near the last thoracic and the first lumbar vertebrae. The spinal cord consists of 31 segments, each of which gives rise to a pair of spinal nerves. These nerves branch out to various body parts to connect them with the central nervous system.

The Procedure

Upon arrival into the suite, a registered nurse may place a foley catheter into your bladder to collect and monitor your urine output. You will then be placed onto your stomach for the procedure. Your arms will be put into the “superman” position (arms straight out, next to and over your head). An anesthesiologist will be giving you medications through an intravenous line to sedate and relax you. You will also be connected to an EKG machine to monitor your heart rate and rhythm, blood pressure and oxygenation continuously. You will hear the technologist, nurse and doctors setting up the equipment/supplies for the procedure and they will talk to you at various points along the way to tell you what is going on. You will need to be very still. It is important that you try your best to be still. Occasionally, general anesthesia may be required. This will improve the results of the x-ray images and minimize the length of your procedure.

The skin on your back, overlying the fractured vertebrae to be treated will be washed with special soap and then draped with sterile sheets and towels. This area will be anesthetized with numbing medication and a special needle is then advanced into the affected vertebrae under fluoroscopic (x-ray) guidance. When the needle tip is in position, an injection of contrast (dye) is performed to provide the doctors with a blood vessel map and make sure there are no abnormal blood vessel connections. This insures correct needle placement prior to injecting the cement. Once the correct placement of the needle is confirmed, treatment may begin.

Vertebroplasty

First, a medical cement is mixed together with a material that shows up on xray (contrast). This allows the doctors to see the mixture actively going into the bone on the x-ray screens. Secondly, an antibiotic may be added to the mixture to reduce the risk of infection. As soon as the cement and all of the ingredients are mixed together, it forms a liquid mixture. This mixture now begins to harden rapidly, so the doctors must work quickly and efficiently. When enough of the cement is injected into the damaged bone, as seen on the x-ray, the needle is removed and gentle pressure is applied over the puncture site. No stitches are required and you are left only with a band-aid.

The procedure will take one to several hours, depending on the number of segments to be treated, as well as on the type of anesthesia required.

After the Procedure

As soon as the procedure is completed, a CT scan may be performed. You will then be transferred onto a stretcher and remain either on your stomach or be put onto your back for up to two additional hours. This allows complete curing of the cement prior to standing. Your recovery time will be spent in Ambulatory or Same-Day Surgery.

You will begin on clear liquids and quickly advance to your normal diet as tolerated.

The nurse will assist you for your first time up, as you may be tired from the medications and/or light-headed from being flat for so long.

Most of our patients go home the same day, some as soon as 3 hours after the procedure is completed. Arrangements for a family member or a friend to drive you home should be made prior to your discharge. Your activities at home can be increased as tolerated. Please do not attempt any strenuous activity at first. Be gradual and use your common sense to guide you. You may feel so good that you forget you did have a major procedure done. No heavy lifting is advised for up to one week; e.g., nothing heavier than a pocket book or a small bag of groceries.

Follow-Up

Depending on the specifics of your condition, you may be referred to a physical therapist or other rehabilitation services as needed. Also, you may receive an exercise instruction sheet if your doctor has prescribed such activities. A follow-up appointment within 2-3 weeks will be arranged.

Your back pain may be relieved immediately or within a few days. If not, you are required to be re-evaluated for other possible causes by your referring physician. There is a possibility that similar pain can occur in a different location. This indicates that you may have developed another fracture. If so, you should contact us for further evaluation and treatment.

Acknowledgement:

American Society of Interventional & Therapeutic Neuroradiology (ASITN) website, embodies the text above. Reproduced with permission.

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