Vertebroplasty

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Video on Vertebroplasty/Kyphoplasty

Sample history: An 82 year woman who came to her doctor with severe back pain without any known cause. Her x-rays showed a fracture of one of the large bones in her back which may have occurred when she was leaning over to make her bed or some other minor physical activity.

She was given the usual conservative treatment of pain medicine and told to stay in bed, but this did not help. Her doctor referred her to a radiologist who has special training and experience in treating her back fracture. He is a specially trained radiologist who performs image guided procedures of many different organs and is called an Interventional Radiologist. The Interventional Radiologist conducted a careful evaluation of her back pain and ordered an MRI scan of her back. The MRI scan showed that her fracture was not healed and was causing her pain.

The radiologist then suggested that she have a procedure performed to eliminate her back pain and let her resume her normal activity.

The Interventional Radiologist explained that there are two procedures used to treat such fractures. One is called Vertebroplasty – vertebro refers to one of the bones in the back called vertebrae and plasty means repair. The other is called Kyphoplasty which will be explained later.

He told her that vertebroplasty is not really new and was started in France over a decade ago. It has been done in the United States since 1993 with excellent results.

The procedure is done on an outpatient basis and the patient usually comes to the hospital the morning of the procedure for an IV line to be placed and laboratory values to be checked.

The procedure is done in the Radiology or X-Ray department in a special room used for procedures requiring image guidance. The patient is usually given IV sedation and local anesthesia so they are comfortable during the procedure. The patient is placed on the special x-ray table on their abdomen and their back is marked and washed with antiseptic solution and covered with a sterile drape. The Interventional Radiologist injects a small amount of local anesthesia into the skin and soft tissue over the fractured back bone to make the area numb. He then uses a special x-ray fluoroscope to direct a needle through the skin and soft tissue into the affected back bone. This is done using different planes or angles of view to allow him to place the needle safely into the center of the fractured bone.

Once the needle is in place, the Interventional Radiologist mixes a medical cement, polymethylmethacrylate (PMMA), for injection into the affected bone. This PMMA has been used for many years by orthopedic surgeons for joint replacement surgery and is safe and strong. The PMMA is mixed with sterile barium so the cement can be well seen during injection of the cement. The patient is usually given an antibiotic through the intravenous line to reduce the chance of infection. The Interventional Radiologist injects the cement slowly while he is watching very carefully to see that the cement enters the fractured bone in the appropriate distribution. The injection is not painful. The needle is removed and the cement allowed to harden. The cement hardens in 10 to 15 minutes and the patient remains on the examination table for this time.

Kyphoplasty is very similar to vertebroplasty but uses balloons to make a cavity in the fractured bone and attempts to elevate the fracture if there is significant compression or loss of height. Once the balloons are inflated, they are removed before the PMMA is injected.

The procedure takes one to two hours depending on the number of fractures that are treated. The maximum number of fractures treated in one sitting is three or four.

After vertebroplasty, the patient is moved to an observation area for two hours. They will remain in bed for about an hour and then are allowed to get up and move about until they are dismissed. After Kyphoplasty, the patient is usually admitted to the hospital and stays over night for observation. The Interventional Radiologist is available on call at any time to answer any questions.

The patient will find a small dressing over the injection site. This dressing should be changed every day with a band aid – this skin entry site is very small. The patient is asked to keep the site clean and dry for three or four days.

The patient usually has significant pain relief and can increase their activity level gradually over time. Care should be taken to not over do the increased activity so that other back bones do not become fractured.

Studies have shown that 75 to 90 percent of patients treated with vertebroplasty have significant or even complete pain relief. There are a few patients who do not improve even with a technically satisfactory procedure.

Most of the patients have osteoporosis causing bone loss which makes their bones more likely to fracture. Patients with other problems causing fractures may also be appropriate candidates.

Vertebroplasty and Kyphoplasty are not suitable for back pain from disc disease, spinal canal narrowing or arthritis.

Complication rates are very low and the chance of making symptoms worse is also very low.

The mechanism of action of the cement is thought to be the “cementing” of the multiple fracture lines in the crushed or fractured back bone. Like any other fracture, motion causes pain. The cement prevents motion and thereby eliminates pain.

At Radiology Associates of Tarrant County, over 300 vertebroplasties/kyphoplasties have been performed. No procedure related complication have been encountered and no one has been made worse. A few patients have not improved, but most patients have had significant improvement.

Please give us a call if you have any questions or want to know if you are a candidate for the procedure. Please call 817 250 3566 and ask to speak to Dr. Richard S. Pickering.

Other links:

Massachusetts General Hospital Vertebroplasty


www.radiologychannel.net/vertebroplasty/