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Conditions & Treatments |
VertebroplastyConditionWhat is a vertebral fracture?A vertebral (spine) fracture occurs when the usual rectangular shape of the bone becomes compressed and distorted, causing pain and in some cases, disability. These compression fractures, which may involve the collapse of one or more vertebrae in the spine, are a common symptom and result of osteoporosis. They are also sometimes caused by trauma or cancer. TreatmentWhat type of treatment is available for vertebral fractures? Vertebroplasty is the injection of cement-like material (bone mineral substitute) into a collapsing vertebral body. The procedure is performed to reinforce the fractured bone, alleviate chronic back pain and prevent further vertebral collapse. The cement-like material stabilizes and strengthens the crushed bone.When should I consider Vertebroplasty? Candidates for Vertebroplasty include men and women who have chronic back pain (at least 6 weeks) and debilitation due to vertebral body fracture or disc herniatiion. Patients often have limited mobility and cannot perform routine daily activities, such as bathing, dressing and walking. Vertebroplasty is usually performed after conservative treatments (bed rest, back brace, oral pain medications) have failed. Most patients are elderly (average age 70 years), but younger patients with osteoporosis, due to metabolic disorders or long-term steroid treatment, may also benefit from Vertebroplasty. Some patients with vertebral destruction from malignant tumors are also candidates for Vertebroplasty.  Not all patients with vertebral fracture are appropriate candidates for Vertebroplasty. Careful screening is critical to ensure that symptoms are due to the vertebral fracture, rather than another problem. It is not enough that patients have a vertebral fracture, since a healed fracture should not cause pain. Thus, it is necessary to exclude other potential explanations for back pain, such as disc herniation, severe arthritis and compression of the spinal cord or nerve roots.What should I expect BEFORE Vertebroplasty? All patients must be evaluated by one of our staff prior to Vertebroplasty. Sometimes a telephone interview is sufficient, but usually patients must be seen in person. The evaluation includes a directed history and physical examination and blood tests. Often, patients can point to a single painful spot. If the location of pain matches the level of fracture seen on standard radiographs (x-rays), then there is a good chance that Vertebroplasty will be successful. If a patient is receiving anti-coagulation treatment (coumadin), it is necessary to stop the medication until coagulation returns to normal. In patients who cannot discontinue their coumadin, it may be necessary for brief hospitalization and intravenous treatment (heparin). At our initial evaluation, patients should bring any imaging studies that were not performed at MGH. It is essential that all patients have recent plain radiographs and MRI. If MRI cannot be performed (due to a cardiac pacemaker, for example), CT scan is necessary. Some patients may need examination under fluoroscopy or bone scan. What should I expect DURING Vertebroplasty?  Vertebroplasty is a non-surgical procedure that is performed using state-of-the-art imaging (fluoroscopic) guidance. The procedure is usually performed in the morning. Patients must be able to lie face down for 1-2 hours. Some patients with severe emphysema or other lung diseases may have difficulty lying in this position. Our team of professionals will make you as comfortable as possible. An intravenous line is placed in the arm to decrease anxiety and control pain. Intravenous antibiotics are also administered to prevent infection.After using a local anesthetic to numb the skin and muscle, a needle is positioned in the collapsed vertebral body. We inject a radiology contrast agent (contains iodine) to confirm proper needle placement, followed by the cement-like material. The longest part of the procedure is setting up the equipment and positioning the needle in the collapsed vertebral body. The actual injection of cement takes only 10 minutes. Medical-grade cement is similar to epoxy or glue. It is injected in a liquid form that quickly hardens over 10-20 minutes. We usually obtain a CT scan after Vertebroplasty to evaluate the distribution of cement. What should I expect AFTER Vertebroplasty? Patients usually recover after a few hours and can go home with an adult if the trip is short. Otherwise, patients should plan on staying overnight in a local hotel. Hospitalization is not required unless the patient is extremely frail or requires additional monitoring after the procedure. There may be dull aching at the needle puncture sites during the first 24 hours following the procedure. An ice-pack can help with this discomfort. Tylenol or non-steroidal anti-inflammatory medication is usually sufficient. Narcotic pain medications should be minimized. You should call us if you develop severe or increasing chest or back pain, fever, or neurological symptoms. Patients are called at home approximately 48 hours and 7 days following Vertebroplasty. Otherwise, patients receive follow-up care from their referring or primary care physicians. To hasten recovery and regain satisfactory levels of activity, patients may benefit from physical therapy or short-term back bracing. Osteoporosis should be treated if medical therapy has not already been instituted. Risks associated with Vertebroplasty Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000. 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. Other possible complications include infection, bleeding, increased back pain and neurological symptoms such as numbness or tingling. Paralysis is extremely rare. Sometimes the procedure causes another fracture in the spine or ribs. Our ServiceThe Division of Interventional Neuroradiology provides a full range of diagnostic and image-guided interventional studies of the head, neck and spine. This Division consists of five full-time radiologists, all of whom are board certified in general radiology and fellowship trained with additional specialization in Neurological procedures. In addition, each has extensive training in the use of x-ray equipment, x-ray dye and image interpretation. |
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