Vertebroplasty

A vertebroplasty is a minimally-invasive procedure that involves percutaneous fluoroscopically guided injection of PMMA(bone cement) directly into fractured vertebral body and is used to strengthen broken vertebra caused mainly by osteoporosis and cancer. This procedure is most commonly used for patients who have not shown improvements with pain medication and braces. This procedure can increase a patient's physical activity and prevent future vertebral fractures. Most patients feel pain relief immediately.

Goals :-

• Decreasing pain
• Strengthening spine/ prevent further collapse
• Improving mobility

Indications :-

• Stabilization of painful or progressive osteoporotic & osteolytic VCF in thoracic & lumbar spine
• Painful vertebra due to metastasis (lytic) / M. Myeloma
• Kummel disease ( AVN of V. body)
• Painful vertebral Hemangioma

Contraindications :-

• Fractures which result in
  • significant neurological compromise
  • burst components with significant retropulsion of bone into the spinal canal
  • involve Post. V. body wall
  • morphology restricting V. body access
• Spine infections
• Coagulopathies
• Allergies against PMMA or contrast media
• Solid metastases
  • T1–T5 # if unable to visualize on X-ray(relative)

Advantage :-

• Early intervention may reduce duration of acute pain, duration of immobilisation use of analgesic, further collapse of v. body, respiratory complications
• pain relief : quick and marked, mobility within 24 hrs

Complication :-

Technique related

• Leakage
• Pneumo / Haemo thorax
• Haematoma
• Neurodeficit

Non Technical

• Early- Anaphylaxis, Embolism
• Delayed – Adjacent level fracture

Patient selection :-

Patients who tend to respond best with vertebroplasty-

• One to three levels of fractures
• Focal pain and tenderness corresponding to the level of edema by MRI
• Fracture < 2 months
• Recent worsening of fracture
• No sclerosis of fractured vertebra

Mechanism of pain relief :-

• The mechanism of pain relief after vertebroplasty is not clear.
• One possible explanation is a mechanical immobilization of the fracture and support to the cortex by the cement.
• Another theory suggests that the heat produced during PMMA polymerization causes deafferentation of the fractured vertebra

BEFORE THE PROCEDURE

Prior to scheduling the procedure, we will need to evaluate an MRI, bone scan, or CT scan of your spine showing the fracture. At that time you will be sent for an anesthesia consult and pre-procedure testing. Once scheduled for the procedure, you will be contacted by one of the spine nurses. You will be asked to provide information regarding you current problem, past medical history, and medications. She will provide you with detailed instructions on how to prepare for the upcoming procedure. You will be asked to hold any NSAIDS, Aspirin, or blood thinners such as Coumadin.

THE DAY OF PROCEDURE

Prior to arrival we ask that you refrain from eating or drinking after midnight the night before. Please bring your pain medications with you. We do not dispense or provide prescriptions for medications after the procedure. You will need someone to drive you home. Patients without a driver will be rescheduled for another day.

Return to normal activity following vertebroplasty

Patients are instructed to resume activity slowly during the next few days and refrain from driving for 24 hours. They are also instructed to look for bleeding or signs of infection, such as redness, swelling, or drainage from the injection site, and to treat any post-procedure back pain as they had done so previously. Patients are then contacted at intervals of one-day, one-week, and one-month to assess progress.

Procedure :-

Prior to the procedure, local anesthetic will be used to numb the area where a small incision will be made near the spinal fracture. The patient typically receives deep sedation, however, on occasion patients may require general anesthesia to tolerate lying on the abdomen during the procedure. To confirm correct needle placement and prevent displacement of the acrylic, or bone cement, a small amount of contrast medium (barium) is mixed along with the cement.