Vertebroplasty

Introduction

Vertebroplasty is a minimally invasive surgical procedure to treat vertebral compression fractures caused by weakened bones.

The spine, also called the back bone, is designed to give us stability, smooth movement, as well as providing a corridor of protection for the delicate spinal cord. It is made up of bony segments called vertebrae and fibrous tissue called intervertebral discs.

Vertebral compression fractures, or VCF’s, occur when bones in the spine are broken. They can occur from trauma, such as a car accident or fall, but are most commonly the result of osteoporosis which causes weakened bones. VCF’s can also occur from other conditions that cause weakened bones, such as certain cancers or long term steroid use.

Compression fractures occur most commonly in the mid to lower back due to the weight bearing load of the spine. This load can cause weakened vertebrae to become crushed. Symptoms range from severe pain to no pain at all.

Compression fractures can lead to progressive spinal deformity. When multiple fractures occur, a condition known as Kyphosis, or dowager’s hump, causes the back to become rounded and bent forward which can affect quality of life making it more difficult to breathe, eat, walk, or sleep.

Vertebroplasty is an elective surgery to treat painful compression fractures of the spine that have not responded to conservative treatment measures such as rest, medication, or back bracing.

The ultimate goal of the surgery is to:

• Alleviate or reduce the patient’s pain
• Restore the fractured vertebra to its pre-fracture height
• Improve spine functionality
• Restore normal alignment of the spine

Indications

Indications for Vertebroplasty surgery include:

• Vertebral Compression Fractures due to osteoporosis.
• Vertebral Compression fractures caused by weakened bones in patients with diagnoses such as metastatic cancer, kidney disease, lymphoma, and multiple myeloma.
• Severe pain and deformity related to a vertebral fracture that is unrelieved by conservative treatments such as pain medications and bracing

Diagnosis

Evaluating the source of back pain is critical in determining your options for pain relief and the location of where to perform surgery. Your doctor will take your medical history and perform a physical examination. Diagnostic Studies to confirm a vertebral fracture and its cause may include:

• X-rays: A form of electromagnetic radiation that is used to take pictures of bones.
• MRI: Magnetic and radio waves are used to create a computer image of soft tissue such as nerves and ligaments.
• CT scan: This test creates 3D images from multiple x-rays and shows your physician spinal structures not seen on regular x-ray.
• Bone Density Test: A test used to diagnose osteoporosis using special x-rays to determine bone density or strength.

Procedure

The surgery is performed under sterile conditions in the operating room with the patient under general or local anesthesia and lying face down on the operating table.

• Your doctor will make a very small nick in the skin over the fracture site.
• Under live X-ray guidance, a hollow needle called a trocar is introduced through the back where it is positioned within the fractured vertebrae.
• Medical grade bone cement is then injected into the area through the trocar.
• X-rays or CT scans may be done to confirm effective distribution of the bone cement.
• The trocar is then withdrawn, pressure is applied, and a sterile bandage is placed.

Postoperative Care

Many patients feel immediate pain relief following vertebroplasty. Others may take a few days or weeks before showing improvement. Most patients are discharged to home the same day.

• You should rest in bed for the first 24 hrs. but can get up to use the bathroom.
• Pain medication will be given to make you comfortable for the first few days.
• Ice packs placed over a cloth can be applied to the surgical area for 20 minutes every hour.
• You will be restricted from heavy lifting or strenuous activities for the first 6 weeks.
• A postoperative rehabilitation program may be prescribed by your doctor to strengthen spinal muscles two weeks after your surgery.

If you have been diagnosed with Osteoporosis, it is important for you to follow up with your physician for medical treatment of your condition.

Risks

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

Complications can be medical (general) or specific to spinal surgery.

Specific complications of Vertebroplasty surgery include:

• Nerve damage or spinal cord injury from leaking cement
• Deep or superficial wound infection
• Bleeding
• Increased back pain
• Numbness and tingling