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Traditionally,
vertebral fractures have been treated with analgesics, braces and
bed rest. Methods such as these have proven to be ineffective. Percutaneous
vertebroplasty is a minimally invasive procedure which has demonstrated
highly successful outcomes. Vertebroplasty is an image-guided, non-surgical
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. Success rates as high as 90% have been
reported world wide. Often performed on an outpatient basis, vertebroplasty
is accomplished by injecting an orthopedic cement mixture through
a needle into the fractured bone. What is a compression fracture? Vertebrae are the bones of the back which join together to make up the spinal column. In a compression fracture of the vertebrae, the bone tissue of the vertebral body collapses. More than one vertebra may be affected. With multiple fracture skyphosis, a forward hump-like curvature of the spine may result. Pressure on the spinal cord may occur, producing symptoms of numbness, tingling or weakness. Symptoms
depend on the area of the back that is affected. In some cases,
the fracture heals without treatment and the pain goes away. In
others, the bone does not stabilize and continues to move, causing
persistent pain that in turn limits physical activities and reduces
independence. What causes vertebral body compression fractures? The leading cause of vertebral body fractures is osteoporosis. Osteoporosis is a condition where the bone becomes thin and weak, losing valuable minerals. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse causing significant pain and subsequently, the loss of movement. An estimated ten million people in the United States suffer from osteoporosis according to the National Osteoporosis Foundation. Osteoporosis
currently accounts for more than 1.5 million fractures a year, 700,000
of which are vertebral compression fractures. The majority of these
include fractures due to the use of steroids used to treat asthma,
lupus and rheumatoid arthritis. The loss of bone and minerals causes
the bone to become so weak that a simple cough, sneeze or sudden
movement can cause a vertebral fracture. When the fracture occurs
as the result of osteoporosis, the vertebrae in the thoracic (chest)
and lower spine are usually affected and symptoms may become worse
with walking. What are the possible residual effects of a vertebral fracture? The
chronic back pain associated with a vertebral fracture severely
inhibits the patient's way of life. The patients are often bed-ridden
and forced to depend on others for everyday activities. Other effects
can be decreased lung capacity, loss of appetite and malnutrition.
Increased morbidity rates and sleeping disorders have also been
proven to be associated with vertebral fractures. Each of these
also may lead to other disorders as well. What are the leading causes of osteoporosis? The
following factors will increase the likelihood of acquiring osteoporosis: Who are the best candidates for vertebroplasty? People
who have experienced vertebral fractures causing moderate to severe
back pain despite conservative therapy such as bed rest and pain
relieving medications are the primary candidates for this procedure.
Vertebral fractures are best treated the earlier they are diagnosed. How should I prepare for the procedure? First, you will be clinically examined. The evaluation generally includes diagnostic imaging, blood tests and a physical exam. Diagnostic imaging such as spine x-rays, a radioisotope bone scan or magnetic resonance imaging (MRI) will be done to confirm the presence of a compression fracture that is amenable to vertebroplasty. If an MRI cannot be performed because of a pacemaker or other medical factor, a CT scan can be substituted. In preparation for the clinical evaluation and physical exam, you should obtain and bring with you any previous diagnostic images, especially x-rays or MRI films. Notify your physician of your current medications including your daily dosages and of any allergies to medications, current infections, high blood pressure, diabetes, asthma or any other abnormal conditions. Be sure to tell your doctor if you are allergic to x-ray contrast material, which contains iodine. Pre-procedure instructions: Do not eat for at least six hours before the procedure. If you are diabetic, you should contact your doctor for instructions on regulating your blood sugar and medications. On the day of the procedure, if your doctor instructs you to take your usual medications, swallow your medication with sips of water or clear liquid up to three hours before the procedure. Avoid drinking orange juice, cream and milk. If
you take an anti-coagulation medication (blood thinners such as
Coumadin), you will have to stop the treatment until coagulation
becomes normal, usually within three to five days. Do not take any
aspirin or aspirin containing products (such as Alka-Seltzer or
Pepto-Bismol) for five days before your procedure. Do not take any
herbal remedies, such as ginkgo biloba, for five days prior to your
procedure. Do not take NSAIDs (ibuprofen) for three days prior to
your procedure. Contact your doctor before stopping any medication
to determine if it is safe for you. All patients should arrange
for an adult to drive them home after the procedure. What does the equipment look like? A hollow needle (trocar) is passed into the vertebral bone and a cement mixture including polymethylmethacrylate (PMMA), barium powder and a solvent is injected. The cement mixture resembles toothpaste or epoxy. The physician will monitor the entire procedure on a fluoroscopy imaging screen and make sure that the cement mixture does not back up into the spinal canal. Sedation
medication will be administered through an intravenous catheter.
You will be attached to the equipment that monitors your heart beat
and blood pressure throughout the procedure. Vertebroplasty
is highly effective because after osteoporosis has made bones very
porous, the cement fills the spaces and strengthens the bone so
it is less likely to fracture again. After vertebroplasty, the cement
stabilizes the fracture, which is thought to provide pain relief.
Patients begin regaining mobility within 24 hours and are usually
able to reduce, or even eliminate, their pain medication. How is the procedure performed? Vertebroplasty is generally performed in the morning. You will be sedated and receive a local anesthetic to numb the skin and the muscles near the spinal fracture. Intravenous antibiotics may also be administered to prevent infection. Through a small incision and guided by a fluoroscope, a hollow needle is passed though the spinal muscles until its tip is precisely positioned within the fractured vertebra. Once the needle is shown to be in the proper location, the orthopedic cement is injected. Medical-grade cement hardens quickly over the next 10-20 minutes. The longest part of the vertebroplasty involves setting up the equipment and making sure the needle is perfectly positioned in the collapsed vertebra. Vertebroplasty
usually takes less than one hour (longer if more than one site is
being treated). Although you will not be allowed to drive after
the procedure, you can go home with an adult. What will I experience during the procedure? You
will be lying face down throughout the procedure. Sedation medications
will help you stay calm and minimize any discomfort you might feel
during the vertebroplasty. You will be conscious, though drowsy,
and able to hear anything that is said in the room. During the procedure
you will be asked questions such as "Does this hurt?"
It is important for you to be able to tell your doctor whether you
are feeling any pain. Because of the position you will be in, you
will not be able to see the image on the fluoroscope. What happens after the procedure? Your physician will instruct you on specific post-procedure recommendations and offer consultation on recovery following your procedure. Most patients are able to bear weight very soon after vertebroplasty. They can get up to walk after resting in bed for about an hour. Patients may have liquids if no nausea is experienced and may advance to regular diet if liquids are tolerated. The patient may be discharged with an adult approximately two hours after the procedure if recovery is uneventful. For two or three days afterward, you may feel a bit sore at the point of the needle insertion. You can use an icepack to relieve any discomfort but be sure to protect your skin from the ice with a cloth; use the pack for only 15 minutes per hour. The tiny incision will be closed with a strip of tape and covered with a bandage that should remain on for several days. It is important that the injection site remain clean. You can shower while the bandage is still on. Rest is recommended for the first 24 hours following vertebroplasty. Increase your activity gradually and resume all your regular medications. If you take blood thinners, check with your doctor, but you may be able to restart them after the procedure. Usually,
patients will receive follow-up calls within the first week after
vertebroplasty to check on their progress and answer any questions.
Patients are instructed to call if they experience new back pain,
chest pain, lower extremity weakness or fever over 100 degrees.
The referring physician or primary care provider provides follow-up
care. What is the cost of vertebroplasty? Vertebroplasty is covered by Medicare and most other insurance programs. Co-pays and deductibles will vary based on your specific plan and the Medicare program for each particular region. What are the benefits vs. risks? Benefits ·
Because the pain of a compression fracture is alleviated by vertebroplasty,
patients feel significant relief almost immediately. After just
a few weeks, two-thirds of patients are able to lower their doses
of pain medication significantly. Many patients become symptom-free. Usually, vertebroplasty is a safe and effective procedure. ·
A small amount of orthopedic cement can leak out of the vertebral
body. This does not usually cause a serious problem, unless the
leakage moves into a potentially dangerous location such as the
spinal canal.
·
Vertebroplasty is not used for herniated discs or arthritic pain. |
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