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Vertebroplasty is used to treat pain caused by osteoporotic compression fractures. After menopause, women are especially vulnerable to bone loss. More than one-fourth of women over age 65 will develop a vertebral fracture due to osteoporosis. Older people suffering from compression fractures tend to become less mobile, and decreased mobility accelerates bone loss. High doses of pain medication, especially narcotic drugs, further limit functional ability.

Vertebroplasty is often performed on patients too elderly or frail to tolerate open spinal surgery, or with bones too weak for surgical spinal repair. Patients with vertebral damage due to a malignant tumor may sometimes benefit from vertebroplasty. In rare cases, it can be used in younger patients whose osteoporosis is caused by long-term steroid treatment or a metabolic disorder.

Typically, vertebroplasty is recommended after simpler treatments, such as bedrest, a back brace or pain medication, have been ineffective, or once medications have begun to cause other problems, such as stomach ulcers.

Procedure

This procedure was first done in 1984 by Jansen and Dion in the University of Virginia. During Vertebroplasty, a collapsed vertebra (usually a wedge-shaped vertebral collapse) is assessed and if it meets the criteria for vertebroplasty, it is then accessed via a trocar through which liquid acrylic cement (polymethylmethacrylate – PMMA) material is injected into the vertebral body space and allowed to expand and correct to a significant degree the vertebral collapse that has occurred in the patient. This usually tends to result in significant and often near dramatic improvement in the patient’s pain and symptoms that is not often relieved by other means. In addition spinal axial stabilization is achieved and function rapidly restored.

The actual technique in vertebroplasty requires fluoroscopic guidance and sometimes the use of a CT scan is added. Frequently, vertebroplasty technique can be used at the lumbar level or even the thoracic axial spine level with good results. In osteoporosis, vertebroplasty treatment is done in conjunction with medical treatment and the use of a post-procedure stabilizing corset.

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INDICATIONS

  • Traumatic vertebral wedge compression fracture.
  • Osteoporosis with wedge compression fracture (spontaneous).
  • Aggressive spinal heamangiomas.
  • Selected malignant spinal tumors.

CONTRAINDICATIONS

Osteolytic lesions with collapse associated with loss of vertebral posterior wall integrity as well as epidural invasion by tumors is a relative contraindication. Anticoagulated patients who are on Coumadin should stop Coumadin for about three days with the permission and knowledge of the prescribing physician. Other anticoagulants should also be stopped prior to starting this procedure. Aspirin should not be used in these patients for at least six to seven days before the procedure. Patient’s who are pregnant, or who suspect they may be pregnant, should not undergo any x- ray guided procedure like vertebroplasty. Radiation therapy of spinal tumors may be done before or after vertebroplasty. A young age is a relative contraindication.

COMPLICATIONS

Vertebroplasty can be a challenging procedure and may result in significant complications including worsened pain from inadequate distribution of the liquid acrylic cement, which could result from poor localization of the injectate among others. Special precautions are needed at the thoracic level ( L1 vertebrae and above). Others include infection, bleeding, and allergy to contrast material.

SEDATION

Sedatives are often used, as well as analgesics, during this procedure. It is usually well tolerated. Vertebroplasty is an image-guided, minimally invasive, nonsurgical therapy used to strengthen a broken vertebra (spinal bone) that has been weakened by osteoporosis or, less commonly, cancer. Vertebroplasty can increase the patient’s functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. It is usually successful at alleviating the pain caused by a compression fracture. Often performed on an outpatient basis, vertebroplasty is accomplished by injecting an orthopedic cement mixture through a needle into the fractured bone.

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