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VERTEBROPLASTY
 Procedure
Description
Vertebroplasty is a treatment procedure developed by interventional
radiologists to stabilize broken bones in the spine caused
by osteoporosis. In the procedure, a needle about the size
of a cocktail straw is inserted through the skin and into
the crushed vertebrae. A surgical bone cement called poly-methylmethacrylate
is injected into the bone to stabilize it. This has been likened
to placing a cast inside the broken bone instead of around
it. The doctor is able to guide the needle to the right spot
using special X-ray equipment.
Vertebroplasty
takes approximately 1 hour to perform for a single fracture.
The procedure is performed with a local anesthetic that numbs
the area to be treated and with intravenous (IV) conscious
sedation (“twilight sleep”). Most tolerate the procedure
without discomfort. Patients are kept in bed for 2 hours following
the procedure, then are able to get up and resume activity.
Most vertebroplasties are done on an outpatient basis. Results
are usually apparent within 24 hours. Approximately 80% to
90% of patients, if they are good candidates and carefully
screened, can expect moderate to significant pain relief.
The complication rate is very low.
It
is very important that you be appropriately evaluated to see
if you are a candidate before you are scheduled. All referrals
must come through the physician or provider who is treating
your back pain. The diagnosis of compression fracture(s)
must be confirmed or highly suspected. Other causes of back
pain such as a ruptured disc, pinched nerve, or arthritis
will not benefit from vertebroplasty and can even be aggravated
by it. Most patients need an MRI or CT scan before the procedure
to exclude these other causes and ensure that the fractured
bone is not compressing the spinal cord. Spinal cord compression
also makes a patient ineligible for vertebroplasty. Up to
three vertebrae may be treated at one time. Cervical fractures
are not treated.
When
your doctor contacts us, we will review your office records
and review or schedule your imaging studies (X-rays, MRI,
etc.), then speak with you by phone to arrange either a consultation
or appointment for the vertebroplasty if you are a candidate.
The doctor performing the procedure will meet with you before
to fully explain the procedure and answer your questions.
Patient
Preparation for the Procedure
A nurse will call you the day before and give you full instructions
about how to prepare and where to come. You must have nothing
to eat or drink the morning of the procedure. You should take
your usual medicines except for blood thinners, aspirin, or
diabetes medications.
Patients
should discontinue blood thinners such as Plavix or Coumadin
for 3 to 7 days. Be prepared to tell our medical staff about
any allergies you have as well as all medications you take,
and bring medications with you that you normally would take
during the time you will be at the hospital. You will stay
at least two hours after the procedure. You should plan to “take it easy” the rest of the day.
You
should not drive for 24 hours. Limit lifting or exercise for
several days, even if you feel much better. Patients who have
been in pain for a long time may benefit from physical therapy
following. vertebroplasty
Frequently
Asked Questions about Vertebroplasty
Q:
Is the procedure safe?
Vertebroplasty is very safe. Although it is a relatively new
treatment in the US, vertebroplasty has been performed for
more than a decade at several centers in France with excellent
results. The injection technique also has been successfully
used for a number of years in the US to treat other conditions
in the spine. For example, it is used to treat cancer and
blood vessel abnormalities. The bone cement used to stabilize
the fractured vertebrae has been shown to be safe through
many years of use in joint replacement surgeries and other
orthopedic procedures.
Q:
Who is a candidate for vertebroplasty?
People who have suffered recent compressing fractures that
are causing them moderate to severe back pain are the best
candidates for vertebroplasty. In some cases, older fractures
may be treated, but the procedure is most successful if it
is performed soon after the fracture occurs. The procedure
is not used to treat chronic back pain or herniated disks.
Q:
How successful is vertebroplasty?
Studies have shown that from 75% to 90% of people treated
with vertebroplasty will have complete or significant reduction
of their pain.
Q:
What are the risks or complications?
Vertebroplasty is a very safe procedure with few risks or
complications. In many studies, no complications were reported.
As with any medical procedure, the possibility of complications
will depend on the individual patient. For example, patients
with tumors in the spine or with other serious medical conditions
may be at higher risk for complications from vertebroplasty.
You should always ask your doctor to discuss risks and complications
with you before you undergo any procedure.
Q:
Will vertebroplasty treat or prevent loss of height or "widow’s
hump"?
After a vertebra has fractured, there is typically a loss
of only 20% to 30% of the height of the bone. But over several
weeks, fractures may reoccur and the vertebra flattens out,
until eventually there’s a 70% to 90% loss of height
in the bone. Gradually, the back hunches over and the person
loses height, especially if several vertebrae are involved.
Vertebroplasty cannot reverse this loss of height or kyphosis
(often called “widow’s hump”) in individuals
who already have these conditions.
Some
studies suggest that early treatment of spinal fractures with
vertebroplasty can strengthen the spine and improve the posture,
which may help prevent further fractures that lead to height
loss or kyphosis. Currently, however, there is no evidence
to prove that the procedure will prevent these problems. However,
new research on the horizon is looking at ways to solve these
problems.
Q:
What is the difference between “vertebroplasty”
and “kyphoplasty”?
“Kyphoplasty” is a procedure under investigation
that involves inserting a small balloon at the point where
the vertebra has collapsed. The balloon is inflated to raise
the bone, and then cement is injected into the space. Researchers
hope the procedure will restore or prevent height loss. There
is less evidence in the scientific literature to document
kyphoplasty’s safety and effectiveness than for vertebroplasty.
Kyphoplasty is a more involved procedure than vertebroplasty.
It is generally performed under general anesthesia in the
operating room.
Q:
Do Medicare and other third party payers cover the costs?
Medicare and most private insurers cover vertebroplasty. Check
with your insurer prior to the procedure if you have concerns.
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