Vertebroplasty: Indications and Complications
The vertebral column consists of vertebrae stacked on top of each to form a hollow canal that protects the spinal cord. The vertebrae are classified into cervical (in the neck), thoracic (in the chest), lumber (the waist), sacral and coccygeal depending upon their location. A vertebra consists of a body, pedicles, lamina, facets (which form the joints between the vertebrae) and the spinous and lateral processes. The body forms a major part of the vertebra. Osteoporosis is a condition that causes reduction in the density of the bone, hence predisposing them to fractures. Osteoporosis increases the risk of fracture on the body of the vertebrae. In United states the incidence of vertebral body fractures is 500,000 patients annually. The lifetime risk of osteoporotic vertebral fracture is about 16% in females and 5% in males. Vertebroplasty is one of the methods used to treat vertebral fractures in patients refractory to other treatment modalities. This method helps in pain relief, increases mobility, reduces risk of opioid dependence and reduces the chances of vertebral collapse in the future.
Procedure of Vertebroplasty
Vertebroplasty is a minimally invasive procedure which is performed on an out patient. The duration of the procedure ranges from thirty minutes to two hours. This procedure is done under local anaesthesia wherein medication is introduced into your body to numb a specific area. Your doctor might also give you medications to reduce your anxiety. After the effects of the anaesthetic drugs take effect your doctor will introduce a needle into the fractured vertebral body via your back. This is done under fluoroscopic guidance. The needle is gently introduced into the body with tapping by a sterile hammer. Once the needle has been positioned correctly your doctor will slowly inject a mixture of bone cement (made of polymethylmethacrylate) and barium sulphate( opacifying agent, helps in visualisation under x ray) into the vertebral body until it is adequately filled. The needle is then withdrawn gently and sterile dressing is applied at the site of the procedure.
Indications for Vertebroplasty
Vertebroplasty is indicated for patients experiencing vertebral fracture because of:
- Osteoporosis: a condition that causes a reduction in the density of the bone.
- Spinal tumours
- Vertebral hemangioma
Preparation for Vertebroplasty
Your doctor would like to record the history of your illness and do a thorough physical examination in preparation for the procedure. An x ray or a CT scan may be requested to better assess the extent and location of the disease. Your doctor would also like to know about the medications that you are taking and may ask you to stop taking any blood thinners before the procedure. Inform your doctor if you have a bleeding disorder.
Complications of Vertebroplasty
Vertebroplasty is a relatively safe procedure with complications seen in 1-3% of the patients. They are:
- Bleeding
- Nerve root irritation
- Fracture of the pedicle of the vertebra
- Fracture of rib
- Infection
- Flow of cement into the surrounding structure before it hardens
- Fever.
Recovery from Vertebroplasty
Following a vertebroplasty you may experience an increase in pain for the first few hours until the cement cure. After the procedure you will be requested to lie on your back for an hour while you are under observation. You will be allowed to go home after that. It is advisable to arrange for someone to drive you home. Pain relief is experienced in the first 72 hours itself. The pain due to the procedure can be managed with the help of over the counter pain medications from your doctor. After the procedure your doctor will prescribe medications to treat your osteoporosis, which includes modifications in lifestyle, medical management and dietary supplementation. Without this nearly 20% of the patients experience another vertebral body fracture.
Sources
- John Hopkins medicine- health library
- Percutaneous Vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study.
- 3. AJNR Am J Neuroradiol. 2007; 28(3):555-60
