Vertebral augmentation is a medical procedure designed to address specific spinal conditions. This minimally invasive intervention involves injecting a specialized bone cement into a fractured spinal bone, known as a vertebra. The primary purpose of this technique is to alleviate back pain resulting from these fractures and to stabilize the affected area.
Conditions Treated by Vertebral Augmentation
Vertebral augmentation primarily treats vertebral compression fractures (VCFs). These fractures occur when spinal bones break and collapse, often leading to a wedge-shaped deformity.
The most common cause of VCFs is osteoporosis, a condition that weakens bones, making them brittle and susceptible to fracture from minor stresses. VCFs can also result from high-energy trauma, such as falls or car accidents, or from metastatic tumors that spread to the spine.
Individuals with VCFs often report sudden, severe back pain that worsens with movement but may find some relief when lying down. Over time, these fractures can lead to height loss and kyphosis, a stooped posture. In some cases, nerve compression can occur, causing tingling, numbness, weakness, or issues with bladder or bowel control.
The Vertebral Augmentation Procedure
The vertebral augmentation procedure is minimally invasive, typically performed with local anesthesia and mild sedation, though general anesthesia may be used. The patient lies face down, and a small incision is made over the fractured vertebra.
Fluoroscopy, a real-time X-ray imaging technique, guides a hollow needle into the fractured spinal bone. Once positioned, the procedure diverges into two main types: vertebroplasty and kyphoplasty.
In vertebroplasty, bone cement (polymethylmethacrylate or PMMA) is directly injected into the fractured vertebra. This medical-grade cement hardens quickly, typically within 10 to 20 minutes, stabilizing bone fragments and providing internal support.
Kyphoplasty involves an inflatable balloon-like device. After needle placement, the balloon is inserted and gently inflated to create a cavity. This inflation can help restore lost vertebral height and correct spinal alignment. The balloon is then deflated and removed, and the created space is filled with PMMA cement. The procedure usually takes less than an hour per treated vertebra.
Recovery and Outcomes
Following vertebral augmentation, patients are monitored for a few hours for stability and recovery. Most individuals return home the same day.
Vertebral augmentation primarily aims to provide significant pain relief, often experienced rapidly within 24 to 48 hours. The bone cement’s stabilization helps reduce pain, leading to improved mobility and spinal stability.
Patients are encouraged to resume light activities soon after. For kyphoplasty, an added benefit is potential restoration of vertebral height and reduced spinal curvature.
Determining Eligibility for Vertebral Augmentation
Candidacy for vertebral augmentation involves a thorough evaluation. Individuals considered are those with painful vertebral compression fractures, especially when pain correlates directly with the fracture site. The procedure is often recommended after conservative treatments like rest, pain medications, bracing, or physical therapy have not provided sufficient relief.
Fractures are typically of recent onset, though timing is not always a strict determinant. Certain conditions make vertebral augmentation unsuitable. These include neurological deficits like weakness, numbness, or issues with bladder or bowel control, which could indicate nerve damage.
Other factors precluding the procedure are unstable fractures, such as burst fractures, or those with bone fragments pushed into the spinal canal. Active spinal or systemic infections, bleeding disorders, or known allergies to bone cement also prevent the procedure. Complete vertebral collapse, technical difficulties, or increased risks of cement leakage may lead to avoiding the procedure.