Percutaneous vertebroplasty is a minimally invasive medical procedure performed on the spine. Its primary purpose is to stabilize fractured vertebrae and alleviate pain, particularly in patients experiencing severe discomfort from vertebral compression fractures. The term “percutaneous” indicates that the procedure is performed through the skin, avoiding the need for large incisions. “Vertebroplasty” refers to the repair or augmentation of a vertebra, one of the bones that make up the spinal column. This technique involves injecting a specialized bone cement directly into the fractured bone, providing immediate structural support.
Conditions Treated by Vertebroplasty
Vertebroplasty is primarily used to address vertebral compression fractures (VCFs), which occur when a spinal bone collapses or compresses. The most frequent cause of VCFs is osteoporosis, a condition characterized by weakened and brittle bones that become susceptible to fractures even from minimal trauma, such as bending or twisting. Osteoporosis-related VCFs commonly affect older adults, particularly postmenopausal women, due to hormonal changes that lead to reduced bone density.
Beyond osteoporosis, VCFs can also result from spinal tumors, including both benign growths and malignant cancers that have spread to the spine, such as metastatic cancer or multiple myeloma. These tumors can weaken the vertebral structure, making it prone to collapse. Less commonly, severe trauma from incidents like falls, sports injuries, or vehicle accidents can also cause VCFs.
The Vertebroplasty Procedure Explained
Before the vertebroplasty procedure, patients receive instructions to fast and discuss their current medications with their doctor. The procedure is usually performed under local anesthesia combined with conscious sedation, allowing the patient to remain relaxed yet responsive. The patient is positioned face down on the operating table to provide optimal access to the spine.
Imaging guidance, most commonly fluoroscopy, which provides real-time X-ray images, is used throughout the procedure to ensure precise needle placement. A hollow needle is inserted through the skin and guided into the fractured vertebral body. Once the needle is positioned within the bone, medical-grade bone cement, typically polymethyl methacrylate (PMMA), is injected.
The bone cement has a consistency similar to toothpaste and begins to harden quickly, usually within 10 to 20 minutes, forming an internal cast that stabilizes the fractured vertebra. This minimally invasive process typically takes about an hour to complete, and the needle is withdrawn before the cement fully sets. The goal is to provide mechanical stabilization and reduce pain by reinforcing the weakened bone.
Recovery and Potential Outcomes
Following a vertebroplasty, patients are typically observed for a short period, often discharged on the same day, though some may require an overnight stay, especially if frail or with other medical conditions. The injection site in the back may feel sore for a few days, which can be managed with ice packs and pain medication. Patients experience pain relief within 24 to 72 hours, with some reporting immediate relief.
Patients are advised to take it easy for the first 24 hours and avoid strenuous activities for about six weeks. Many can resume their normal daily activities within a few weeks after the procedure. While vertebroplasty is considered safe and effective for pain relief, potential complications can occur, though they are not common.
Complications include infection at the injection site, bleeding, or blood clots. Cement leakage can occur, where the injected PMMA cement may extravasate into surrounding areas. While often asymptomatic, cement leakage can lead to severe issues like nerve damage or spinal cord compression.
Candidate Selection and Alternatives
Candidates for vertebroplasty are individuals experiencing recent, painful vertebral compression fractures that have not improved despite conservative treatments. These conservative approaches include bed rest, pain medications, and external bracing, tried for 3 to 6 weeks. Patients with severe pain directly correlating to the fracture site are considered.
There are specific reasons why someone might not be eligible for vertebroplasty, known as contraindications. These include an active systemic or spinal infection, as the procedure could spread the infection. Bleeding disorders or an allergy to the bone cement (PMMA) are also factors. Vertebroplasty is not recommended for asymptomatic fractures or fractures with significant spinal canal compromise causing neurological symptoms.
Other treatment options for vertebral compression fractures are considered during patient evaluation. Kyphoplasty is a similar minimally invasive procedure that involves inserting a balloon into the fractured vertebra to create a cavity and potentially restore some vertebral height before injecting the bone cement. Conservative management, which involves non-surgical treatments like rest, bracing, and pain control, remains an initial approach.