Learn More About Vertebroplasty

Vertebroplasty, or vertebral augmentation, is a minimally invasive, out-patient procedure and treatment to alleviate chronic back pain caused by vertebral (spinal bones) compression fractures. Spinal compression fractures can occur either by osteoporosis or by trauma. These compression fractures occur when the normal vertebral body of the spine is compressed to a smaller height.

A relatively new procedure, Vertebroplasty has shown amazing results time and time again. Vertebroplasty is an outpatient procedure that is performed by injecting medical grade acrylic cement into the fractured vertebra. Patients are given local anesthesia and light sedation for the procedure. The needle is placed with fluoroscopic (x-ray) guidance for proper placement. The cement dries quickly and then creates a support structure within the vertebra to provide stabilization and strength. Once set, the cement can cause rapid pain relief, as it eliminates the compression due to the fracture. Most patients experience pain relief immediately, with a small percentage noting pain relief later after the procedure.

This relatively new and innovative treatment option has helped people when conservative therapies have failed or haven’t provided adequate pain relief (De Negri 2007). Vertebral compression fractures are when the vertebrae develop small cracks, break, or collapse/compress, compromising the spine and other nearby structures in the body. Kyphoplasty is a similar procedure, but differs with the inflation of a special balloon.

Secondary Conditions commonly treated with Vertebroplasty include:

  • Osteoporosis
  • Bone cancer metastasis
  • Injury or Trauma

Procedure

Once the area is sterilized and a local-numbing agent is administered, and possibly a mild sedative, the physician makes a small incision in the patient’s back. A. narrow and hollow tube is inserted into the vertebra to withdraw any dead or damaged tissues.

Image devices, such as fluoroscopy or X-ray, are used to guide the physician to ensure correct needle and bone cement placement. Medical bone cement is injected from the needle through the hollow tube, and into the damaged vertebral body. The bone cement quickly dries to form a support structure within the vertebra. This provides improved spinal stabilization and strength. After the procedure is completed, the incision site on the skin is covered with a small bandage.

Vertebroplasty Benefits

Vertebroplasty is a widely-accepted and innovative procedure with proven results to provide pain relief, increase vertebral body height, and decrease wedge angle (improper shape) without worsening of the retropulsion (backward movement) of the vertebrae (Hiwatashi 2007). Many Patients with compression fractures often have kyphosis.

Kyphosis (hump back or round back) is a pronounced curving of the upper back. There is more than one cause, but a common cause is vertebral compression fractures, which often occur with Osteoporosis. Severe kyphosis is a serious health concern; often debilitating and maybe embarrassing for those with an obvious spinal curve.

Vertebroplasty Risks

Vertebroplasty is generally considered a safe and appropriate non-surgical minimally invasive procedure for most patients with chronic back pain, caused by vertebral compression fractures. However, as with any procedure there are potential risks.

Some of the associated risks are from bone cement leakage outside of the vertebral body. Serious complications are extremely rare, but include:  infection, bleeding, numbness, tingling, headache, and paralysis may result from misplacement of the needle or bone cement.

Bone cement misplacement is decreased by the use of fluoroscopy or x-ray, or other radiological imaging devices to ensure proper placement of the bone cement and needle.

Aside from any possible risks, published studies indicate Vertebroplasty as a safe treatment for painful vertebral compression fractures, and complications are rare with the procedure (DaFonseca 2006) (Hiwatashi 2007)

Outcomes

Fracture Prevention

Overall good health including:  balanced diet, regular exercise, weight lifting, calcium and vitamin D supplements are healing and preventive for the spine.

Bisphosphonates medications (Fosamax) may prevent additional compression fractures due to Osteoporosis. These treatments strengthen bones and prevent further bone density losses.

Those suffering from painful compression fractures may be good candidates for minimally invasive procedures that have been proven effective, including Vertebroplasty and Kyphoplasty (Old 2004). Vertebroplasty is a relatively new technique providing therapeutic benefits, like significant pain relief and improved mobility in patients with vertebral fractures.

In a 2007 journal article, a reported 95% of the patients treated with Vertebroplasty and Kyphoplasty procedures had partial or complete and immediate pain relief (Hiwatashi 2007). The American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the management of chronic back pain with interventional techniques. The article concluded that there is evidence for vertebral augmentation procedures to provide moderate back-pain relief and improvement, for both Vertebroplasty and Kyphoplasty. (Boswell 2007).

For more information about Vertebroplasty or Kyphoplasty, or any other items mentioned, please see Portland Pain.

Resources

  • Vertebral height restoration in osteoporotic compression fractures: kyphoplasty balloon tamp is superior to postural correction alone. Shindle MK, Gardner MJ, Koob J, Bukata S, Cabin JA, Lane JM. Osteoporosis Int. 2006 Dec;17(12):1815- 9. Epub 2006 Sep 16 PMID: 16983458.
  • Balloon kyphoplasty in the therapy of vertebral fractures] DaFonseca K, Baier M, Grafe I, Libicher M, Noeldge G, Kasperk C, Meeder PJ. Orthopade. 2006 Oct;35(10):1101-9 PMID: 17195295.
  • Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L.
  • American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025 Vertebroplasty for osteoporotic fractures with spinal canal compromise Hiwatashi A, Westesson PL. AJNR Am J Neuroradiol. 2007 Apr;28(4):690-2 PMID: 17416822
  • Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. De Negri P, Tirri T, Paternoster G, Modano P. Clin J Pain. 2007 Jun;23(5):425-30 PMID: 17515741.
  • Vertebral Compression Fractures in the Elderly. Old, Jerry; Calvert, Michelle. American Family Physician. January 1, 2004