About Vertebroplasty
Vertebroplasty is a treatment for the relief of back pain that has been caused by the compression fracture of the vertebral body. It is a minimally invasive, nonsurgical procedure used to strengthen broken vertebrae (spinal bone) that has become weakened and fractured. Usually the bone is weakened by osteoporosis, long-term steroid use or less commonly, cancer or injury.
Vertebroplasty allows stabilization of a fractured vertebra by the injection of medical grade cement directly into the fractured vertebra using imaging guidance. The cement fills the fracture, stabilizing and strengthening the bone and alleviating pain .
Because the pain of a compression fracture is alleviated by vertebroplasty, patients feel significant relief almost immediately. After just a few weeks, two-thirds of patients are able to lower their doses of pain medication significantly and many patients become symptom-free.
About 75% of patients regain lost mobility and become more active, which helps combat osteoporosis. After vertebroplasty, patients who had been immobile can get out of bed, reducing their risk of pneumonia and deep venous thrombois or blood clots in leg veins. Increased activity builds more muscle strength, further encouraging mobility. Vertebroplasty is usually performed for the treatment of painful compression fractures of the thoracic or lumbar spine.
Before the Procedure
Diagnostic imaging tests are reviewed by our Interventional Radiologists, who will then decide if the patient is a candidate for vertebroplasty. Patients will have an initial telephone consultation with our nurse, approximately one week prior to the appointment. During this interview we will collect information about past medical history, medications taken, allergies, and home support system. On the evening prior to the procedure, you should not eat or drink anything after midnight. You should arrive at least two hours prior to the procedure.
The patient will be sedated and receive a local anesthetic to numb the skin and the muscles near the spinal fracture. During the procedure, the patient will lie on their stomach. Through a small incision, guided by a fluoroscope, a hollow needle is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebrae. This process is monitored with x-ray during the procedure.
Once the needle is shown to be in the proper location, the medical grade cement is injected. When a sufficient amount of bone cement has been placed, the needle is removed. The patient remains on their stomach for a few minutes while the cement begins to harden, approximately 10-20 minutes. After sedation wears off the patient is usually allowed to go home. It is necessary to have someone drive the patient home and stay with them the night of the procedure.
The Patient Experience
Once in the interventional suite, you will be comfortably positioned on your stomach. You will be given pain medication and a mild sedative through your IV to help you feel relaxed. You will be monitored by the physician and a nurse throughout the entire procedure, until you arrive at the recovery area at the conclusion of the procedure. Most patients are discharged home after a short recovery time.
After Your Vertebroplasty
For two or three days afterwards, you may feel a bit sore at the point of the needle insertion. You can use an icepack or heating pad to relieve any discomfort. The tiny incision will be covered with a bandaid, which should remain on for several days. It is important that the site remain clean.
All patients are directed to follow-up with our nurse about two weeks after the vertebroplasty. The radiology staff will also call in one to two days to check on how you are feeling. Risks associated with Vertibroplasty.
Risks of Vertebroplasty
A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem, unless the leakage moves into a potentially dangerous location such as the spinal canal. Other possible complications include infection, bleeding, increased back pain, and neurological symptoms such as numbness or tingling. Paralysis is extremely rare. Sometimes, the procedure causes another fracture in the spine or ribs.
For more information about Back Pain, please call NCTVI at (916) 732-7777
About Kyphoplasty
Kyphoplasty is a minimally invasive spinal surgery procedure used to treat painful, progressive vertebral compression fractures (VCFs). A VCF is a fracture in the body of a vertebra, which causes it to collapse. In turn, this causes the spinal column above it to develop an abnormal forward curve. VCFs may be caused by osteoporosis (an age-related softening of the bones) or by the spread of tumor to the vertebral body. Certain forms of cancer can also weaken bone and cause the same problems.
Kyphoplasty is not appropriate for:
• Patients with young, healthy bones or those who sustained a vertebral body fracture or collapse in a major accident
• Patients with spinal curvature such as scoliosis or kyphosis that results from causes other than osteoporosis
• Patients who suffer from spinal stenosis or a herniated disk with nerve or spinal cord compression and loss of neurologic function not associated with a VCF
Technique
Kyphoplasty involves the use of a device called a balloon tamp to restore the height and shape of the vertebral body. This is followed by application of bone cement to strengthen the vertebra. The procedure is performed with the patient lying face down on the operating room table and under intravenous sedation. Two x-ray machines are used to show the collapsed bones.
To begin, the surgeon makes two small (less than 3 mm) incisions in the back. A tube is inserted into the center of the vertebral body to the site of the fractured bone. The balloon tamp is then inserted down the tube and inflated. This pushes the bone back to its normal height and shape.
Inflation of the balloon creates a cavity in the vertebral body, which the surgeon fills with bone cement. When the cement hardens, the tubes are removed. The incisions are closed with a single stitch, and patients usually go home the same day. Patients can go back to all normal activities of daily living as soon as possible with no restrictions.
It is recommended that kyphoplasty be performed soon after a VCF happens to best restore vertebral body height and size. After kyphoplasty, severe osteoporosis may cause other fractures at other levels of the spine. All patients must take bone-strengthening medications during treatment. If more vertebrae collapse, kyphoplasty can be used at those other levels. Kyphoplasty tends to help prevent additional fractures by keeping the spine aligned in its native upright position. X-ray of collapsed vertebral body before kyphoplasty.
X-ray of spine after kyphoplasty and final cement fill.
Outcomes
Early results show kyphoplasty is a safe and effective method to relieve pain and correct the deformity associated with an osteoporotic VCF. More than 95% of patients rate their treatment a success. Patients are able to return to all of their previous activities, and typically do not need any form of physical therapy or rehabilitation. Because bone cement hardens within 15 minutes, there is really no healing that needs to happen from the patient's standpoint.
Patients occasionally complain of persistent pain after kyphoplasty, but this may be due to irritation of tissues involved in the procedure itself. More than likely, however, persistent pain is due to the underlying arthritis and degeneration of the spine.
Pain resulting from the procedure itself will typically diminish within 2 weeks.
If the pain is due to arthritis in the spine, the usual treatment is medications and an ongoing exercise program.
Complications
Like all surgeries, kyphoplasty does have risks. These risks depend on the patient's overall health. Complications may require additional treatments, including medications or surgery.
• The usual risks of local or general anesthetics apply.
• There is a small risk of bone cement leaking from within the boundaries of the vertebral body. Most of the time, this rare event (less than 10%) does not cause any problems.
• In rare instances, the cement may irritate or damage the spinal cord or nerves. This can cause pain, altered sensation, or even, very rarely, paralysis (estimated risk is less than 1 in 10,000). Should the cement leak further, more significant surgery may be needed to stop the irritation of the nerves or spinal cord.
• There is also a small chance of the cement traveling to lungs. There is an even smaller chance of the cement block becoming infected at the time of surgery or even years later.
