Definition and Overview
Vertebroplasty, which is a common treatment for osteoporosis, is a nonsurgical outpatient procedure that involves injecting a special mixture of cement into a fractured part of a vertebral column (spine or backbone) to fuse fragments, reduce pain, and stabilise and strengthen broken bones.
The vertebral column refers to the stack of bones that encapsulate the spinal cord, which provides body structure and allows a person to be flexible and mobile. Due to certain diseases or injuries, the bones in the column can be fractured. When this happens, broken fragments can slide out, rub against each other, or the bones may compress, hurting the nerves and making the person more susceptible or perceptive to pain. The patient may also become less mobile and flexible.
In vertebroplasty, the orthopedic doctor uses an image-guidance technique like a contrast dye to locate the fractured part of the spine and inject the cement mixture. In certain cases, a procedure called khypoplasty is also performed, wherein a balloon is placed into the problem area to create the space in which the mixture can be injected.
Who Should Undergo and Expected Results
Vertebroplasty is often performed on patients who suffer from osteoporosis, a degenerative bone-related disease that causes the bones to become brittle until they become weak and prone to fracture. Osteoporosis is often linked to old age, vitamin D and calcium deficiency, and menopause.
The procedure is also recommended for people who have bone compression fractures associated with injury including a previous trauma that resulted in a bone fracture, preexisting conditions like cancer or tumour on the spine, previous fracture to the vertebra, serious infections, or abnormalities of the bone like Paget’s disease.
Also, vertebroplasty is intended to those who do not respond quickly or positively to other less invasive treatments including bed rest, medication, and massage therapies.
The quick and simple procedure does not treat any underlying condition that is causing the compression fracture such as osteoporosis and thus, doesn’t prevent recurrences. However, the patient may regain as much as 75% of his mobility and improve his quality of life by reducing or eliminating pain.
How Does the Procedure Work?
The doctor starts by performing a thorough review of the patient's medical history and physical exam to ensure that the patient is fit to go through the procedure. These include complete imaging tests like MRI and X-ray as well as a review of medications and supplements being taken to ensure that they will not cause an adverse reaction to the body once the mixture is introduced.
During the procedure, the patient lies on the operating table in an X-ray room with his face down (prone position) so his back is fully exposed. The doctor then uses a real-time X-ray guidance, usually with the help of a contrast dye, to determine the exact location of the compression fracture.
The targeted area is then applied with an anaesthetic before a trochar or trocar, a surgical instrument with a cavity from which a fluid-like cement mixture is stored and then drained, is gently inserted. In some cases, the surgeon adds a balloon first to define the gap before the injection is made. Depending on how many bones are affected, the desired result, and the general condition of the bone fracture, more than one injection is necessary to correct the problem.
The patient then remains lying face down for at least an hour to allow the cement mixture to harden and a few more hours to rest from the procedure. The doctor may suggest wearing a back brace within the next 24 hours for support.
Possible Risks and Complications
Pain and discomfort are the common complications of vertebroplasty and these can persist within two or three days following the procedure. They may be treated with pain relievers and should subside as the days go by. Otherwise, the patient will have to make a follow-up with his doctor to check if any bone compression fractures were missed. Although rare, the patient may also experience blood loss, irritation of the nerves, infection, cement leak, and even more fractures.
Anselmetti GC, Muto M, Guglielmi G, et al. Percutaneous vertebroplasty or kyphoplasty. Radiol Clin North Am. 2010;48(3):641-9. PMID: 20609898
Esses SI, McGuire R, Jenkins J, et al. The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 2011;19(3):176-82. PMID: 21368099
Williams KD. Fractures, dislocations, and fracture-dislocations of the spine. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 38.