What is Vertebroplasty/ Kyphoplasty?

Vertebroplasty and Kyphoplasty are revolutionary new treatments developed by interventional radiologists to stabilize broken bones in the spine caused by osteoporosis.  VIA Interventional Radiologists were the first in Greater Cincinnati to perform vertebroplasty and have performed more successful vertebroplasties than any group in the Tristate area.  
 

Vertebroplasty

In the vertebroplasty procedure, a needle about the size of a cocktail straw is inserted through the skin and into the crushed vertebrae. A surgical bone cement is injected into the bone. The cement hardens, stabilizes the bone and prevents further collapse. This stops the pain caused by bone rubbing against bone.  
Surgery is not required because the doctor is able to guide the needle to the right spot using special X-ray equipment. Vertebroplasty takes from one to two hours to perform depending on how many bones are treated. The procedure may be performed with a local anesthetic that numbs the area to be treated, or the patient may be given general anesthesia.

Kyphoplasty is very similar to vertebroplasty except that one or two balloons are inflated in the vertebral body to create a cavity in the body prior to cement injection.  This procedure is utilized to treat vertebral compression fractures that may be difficult to manage with vertebroplasty alone.  Your VIA interventional radiologist will assist you in selecting the therapy that is best for your type of fracture.

Frequently Asked Questions About Vertebroplasty

Is the procedure safe?
Vertebroplasty is very safe. Although it is a relatively new treatment in the U.S., vertebroplasty has been performed for more than a decade at several centers in France with excellent results. The injection technique also has been successfully used for a number of years in the U.S. to treat other conditions in the spine. For example, it is used to treat cancer and blood vessel abnormalities. The bone cement used to stabilize the fractured vertebrae has been shown to be safe through many years of use in joint replacement surgeries and other orthopaedic procedures.

Who is a candidate for vertebroplasty?
People who have suffered recent compressing fractures that are causing them moderate to severe back pain are the best candidates for vertebroplasty. In some cases, older fractures may be treated, but the procedure is most successful if it is performed soon after the fracture occurs. The procedure is not used to treat chronic back pain or herniated disks.

How successful is vertebroplasty?
Studies have shown that from 75 percent to 90 percent of people treated with vertebroplasty will have complete or significant reduction of their pain.

What are the risks or complications?
Vertebroplasty is a very safe procedure with few risks or complications. In many studies, no complications were reported. As with any medical procedure, the possibility of complications will depend on the individual patient. For example, patients with tumors in the spine or with other serious medical conditions may be at higher risk for complications from vertebroplasty. You should always ask your doctor to discuss risks and complications with you before you undergo any procedure.

Will vertebroplasty treat or prevent loss of height or "widow’s hump"?
After a vertebra has fractured, there is typically a loss of only 20 percent to 30 percent of the height of the bone. But over several weeks, fractures may reoccur and the vertebra flattens out, until eventually there’s a 70 percent to 90 percent loss of height in the bone. Gradually, the back hunches over and the person loses height, especially if several vertebrae are involved. Vertebroplasty cannot reverse this loss of height or kyphosis (often called "widow’s hump) in individuals who already have these conditions.

Some studies suggest that early treatment of spinal fractures with vertebroplasty can strengthen the spine and improve the posture, which may help prevent further fractures that lead to height loss or kyphosis. Currently, however, there is no evidence to prove that the procedure will prevent these problems. However, new research on the horizon is looking at ways to solve these problems.

How should I prepare for the procedure?

First, you'll be clinically evaluated. 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 (MR) imaging will be done to confirm the presence of a compression fracture that is amenable to vertebroplasty. If an MR 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 MR films. Be sure to tell your doctor if you are allergic to x-ray contrast material, which contains iodine.

Most medical facilities provide patients with pre-procedure instructions. Instructions will typically tell you not to 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 anticoagulation medication (blood thinners such as Coumadin), you will have to stop the treatment until coagulation becomes normal, usually within three to five days. Contact your doctor before stopping any medication to determine if it is safe for you. On the day of the procedure, patients who use blood thinners should report to the hospital a little earlier for a blood test to verify that their anticoagulant has stopped working. If you are unable to interrupt your anticoagulant regimen, a short in-patient stay for intravenous treatment with heparin may be required. 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 is injected. The cement mixture resembles toothpaste or epoxy. The physician will monitor the entire procedure on an fluoroscopy imaging screen to make sure that the cement mixture remains in the area of treatment, and does not migrate into the spinal canal.

Sedation medication will be administered through an intravenous catheter. A Foley catheter may be placed in your bladder. You will be attached to equipment that monitors your heart beat and blood pressure throughout the procedure.

How does the procedure work?

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 the 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 through the spinal muscles until its tip is precisely positioned within the fractured vertebra. Then the interventional radiologist performs an examination called intraosseous venography to make sure the needle has reached a safe spot within the fractured bone. 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. A CT scan may be performed at the end of the procedure to check the distribution of the cement. The longest part of vertebroplasty involves setting up the equipment and making sure the needle is perfectly positioned in the collapsed vertebra.

What will I experience during the procedure?

You'll 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'll be conscious, though drowsy, and able to hear anything that's said in the room. During the procedure, you'll be asked questions, such as, "Does this hurt?" It's important for you to be able to tell your doctor whether you are feeling any pain. Because of the position you'll be in, you won't be able to see the image on the fluoroscope.

For two or three days afterwards, 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, which should remain on for several days. It's important that the injection site remain clean. You can shower while the bandage is still on.

Bed rest is recommended for the first 24 hours following vertebroplasty, though you can get up to use the bathroom. 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 the day after the procedure.

Most patients are able to bear weight very soon after undergoing vertebroplasty. They can get up to walk after resting in bed for about an hour afterwards, and the interventional radiologist can often tell at that point if the procedure was successful. In some cases, it can take a few days for the doctor to be able to make this assessment.

Recovery
Most patients have vertebroplasty or kyphoplasty done in a hospital and stay overnight afterwards. Some patients experience immediate pain relief after vertebroplasty/kyphoplasty. Most report that their pain is gone or significantly better within 48 hours. Many people can resume their normal daily activities immediately.

Who interprets the results and how do I get them?

Usually, patients will receive follow-up phone calls within the first week after vertebroplasty to check on their progress and answer any questions. The referring physician or primary care provider provides follow-up care.

What are the benefits vs. risks?

Benefits

• Because the pain of a compression fracture is alleviated by vertrebroplasty, 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.
• About 75% of patients regain lost mobility and become more active, which helps combat osteoporosis. After vertebroplasty, patients who had been immobile can get out of bed, reducing their risk of pneumonia. Increased activity builds more muscle strength, further encouraging mobility.

Risks
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.
• 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.

What are the limitations of Vertebroplasty?

Vertebroplasty is not used for herniated discs or arthritic back pain.

• Vertebroplasty is not generally recommended for otherwise healthy younger patients, mostly because there is limited experience with cement in a vertebral body for longer time periods.
• The procedure cannot serve as a preventive treatment to help patients with osteoporosis avoid future fractures. It is used only to repair a known, non-healing compression fracture.
• Vertebroplasty will not correct an osteoporosis-induced curvature of the spine, but it may keep the curvature from worsening.
• It may be difficult for someone with severe emphysema or other lung disease to lie facedown for the one to two hours vertebroplasty requires. The healthcare team will try to make special accommodations for a patient with this type of condition.
• Patients with a healed vertebral fracture are not candidates for vertebroplasty.