Vertebroplasty

It is a spinal procedure in which bone cement is injected through a small hole in the skin (percutaneous) into a fractured vertebra with the goal of relieving back pain caused by vertebral compression fractures. It was found not to be effective in treating osteoporosis-related compression fractures of the spine . 

Vertebroplasty is a pain treatment for vertebral compression fractures that fail to respond to conventional medical therapy, such as minimal or no pain relief with analgesics or narcotic doses that are intolerable.

vertebroplasty is a minimally invasive procedure (nonsurgical)  and patients usually go home the same or next day as the procedure. Patients are given local anesthesia and light sedation for the procedure, though it can be performed using only local anesthetic for patients with medical problems who cannot tolerate sedatives well.

During the procedure, bone cement is injected with a biopsy needle into the collapsed or fractured vertebra. The needle is placed with fluoroscopic x-ray guidance. The cement (most commonly PMMA, although more modern cements are used as well) quickly hardens and forms a support structure within the vertebra that provide stabilization and strength. The needle makes a small puncture in the patient's skin that is easily covered with a small bandage after the procedure.

Vertebroplasty dramatically improves back pain within hours of the procedure, provides long-term pain relief and has a low complication rate, as demonstrated in multiple studies.

Indications for Injection of PMMA

• Symptomatic vertebral angioma.
   
• Painful vertebral body tumors and acetabular tumors. In cancer patients, percutaneous cementoplasty is used particularly in symptomatic treatment of osteolytic bone metastases and myeloma. As vertebroplasty is intended only to treat pain and consolidate the weight-bearing bone, other specific tumor therapy should be given in conjunction when appropriate. The use of PMMA is reserved for weight-bearing bone because of the consolidation effect. In other locations, pain can be treated with alcohol or thermoablation techniques.
   
• Severe painful osteoporosis with loss of height and/or with compression fractures of vertebral bodies. Painful compression fractures in patients with osteoporosis refractory to conservative therapy are excellent indications for vertebroplasty. The ideal candidate for vertebroplasty presents within 4 months of fracture and has midline, nonradiating back pain that increases with weight bearing and can be exacerbated by manual palpation of the spinous process of the involved vertebra. However, many patients have multiple fractures and lack sufficient imaging studies to document the age of some or all of the fractures. Others have several adjacent fractures in which it is difficult to determine, by physical examination, the fracture that is symptomatic. In such instances, magnetic resonance (MR) imaging is helpful, with edema within the marrow space of the vertebral body best visualized on sagittal T2-weighted images. Bone scans can be used to help differentiate the symptomatic level from incidentally discovered fractures.

Contraindications

• Hemorrhagic diathesis.
• Infection.
• Lesions with epidural extension. These require careful injection to prevent epidural overflow and spinal cord compression by the cement or displaced epidural tissue.

The absolute contraindications are hemorrhagic diathesis and infection. Patients with more than five metastases or diffuse metastases are not candidates for vertebroplasty. We have never used this technique in children or adolescents.

If the vertebra isn't shored up, it can heal in a compressed or flattened wedge shape. Once this occurs, the compression fracture cannot be treated effectively. It is very important for someone with persistent spinal pain lasting more than three months to consult an interventional Spine physician, and people who require constant pain relief with narcotics should seek help immediately.

Risk Factors for Osteoporosis

Factors that increase the likelihood of developing osteoporosis include:

• Being female
• Being thin or having a small frame
• Advanced age
• A family history of osteoporosis
• Being past menopause
• Abnormal absence of menstrual periods
• Anorexia or bulimia
• A diet low in calcium
• Long-term use of medications such as corticosteroids or anticonvulsants
• Lack of exercise
• Smoking
• Excessive use of alcohol