Vertebroplasty Procedure

Vertebroplasty Procedure

biopsy needle
Fig 2: Biopsy needle
(larger view)

biopsy needle
Fig 3: Acrylic bone cement is injected
(larger view)

biopsy needle
Fig 4: Restored vertebra with hardened cement
(larger view)

The goals of the vertebroplasty surgical procedure are to stabilize the spinal fracture and to stop the pain caused by the fracture. Vertebroplasty is considered a minimally invasive surgical procedure because the procedure is done through a small puncture in the patient's skin (as opposed to an open incision). A typical vertebroplasty procedure, described below, usually takes about 1 hour to complete.

  • The patient is treated with local anesthesia and light sedation, usually in an x-ray suite or operating room on an outpatient basis.
  • A biopsy needle is guided into the fractured vertebra under X-ray guidance through a small puncture in the patient's skin. (Figure 2)
  • Specially formulated acrylic bone cement is injected under pressure directly into the fractured vertebra, filling the spaces within the bone - with the goal of creating a type of internal cast (a cast within the vertebra) to stabilize the vertebral bone. (Figure 3)
  • The needle is removed and the cement hardens quickly (about 10 minutes), congealing the fragments of the fractured vertebra and stabilizing the bone. (Figure 4)
  • The small skin puncture is covered with a bandage.
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Shortly after the cement has hardened, the patient is free to leave the medical facility and can go home the same day. Patients are usually advised not to drive themselves home the day of the procedure, and may need to spend the night at a hotel in the area if they have to travel a long distance. If the patient needs further observation after the procedure, is particularly frail, or will not have assistance at home, a short stay in the hospital may be recommended.

Recovery from Vertebroplasty

For the first 24 hours after vertebroplasty, bedrest is usually recommended. Activities may be increased gradually and most regular medications can be resumed. There may be some soreness for a few days at the puncture site which may be relieved with an ice pack.

Many patients undergoing percutaneous vertebroplasty experience 90 percent or better reduction in pain within 24-48 hours and increased ability to perform daily activities shortly thereafter.6,7,8 Recent research has demonstrated that percutaneous vertebroplasty can relieve pain from vertebral compression fractures for up to nearly three years following the procedure.8,9

Vertebroplasty Providers

Specialists who perform percutaneous vertebroplasty include interventional neuroradiologists, radiologists, pain management physicians, neurosurgeons, and orthopedic spine surgeons. Credentialing requirements for percutaneous vertebroplasty include training in fluoroscopically guided needle placement. In addition, a physician must be educated on acrylic bone cement preparation, cement delivery system set up and the safe delivery of cement into the vertebral body. Vertebroplasty training must include patient selection criteria and patient care protocols.

Potential Risks and Complications of Vertebroplasty

Complications are rare (less than 3%2) with vertebroplasty but include infection, bleeding, numbness/tingling, increased back pain, and paralysis. Other risks include cement extrusion into the vertebral canal leading to spinal cord or nerve root compression, venous embolism (a blood clot that forms within a vein), pulmonary embolism (one or more blood clots blocking an artery in the lungs), and risks of anesthesia. The risk of cement extrusion into the vertebral canal is theoretically less with kyphoplasty than with vertebroplasty due to the difference in injection pressure, although a large randomized controlled study comparing kyphoplasty to vertebroplasty has yet to be published confirming this. It is not yet known whether vertebroplasty or kyphoplasty increases the risk of another fracture in the spine or ribs, but it is known that a patient sustaining an osteoporotic fracture is already at risk for additional fractures.

References:

  1. Do HM. Percutaneous vertebroplasty. Dis Manage Dig. 2004;8:2-4.
  2. Centers for Medicare and Medicaid Services, United States Department of Health & Human Services available at cms.gov. Accessed May 10, 2005.
  3. Agris J, Hussain N, Gailloud P, Murphy K. Meta-analysis comparing the in vivo cement extravasation rates for vertebroplasty and kyphoplasty. Paper presented at the American Society of Spine Radiology; February 15-19, 2004; Miami, Fla.

Complete Listing of References

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Article written by: Huy M. Do, MD