Vertebroplasty - a new procedure for osteoporosis and vertebral compression fractures

What is Vertebroplasty?
Vertebroplasty (pronounced ver-tee-bro-plasty) is a relatively new procedure that promises dramatic relief from painful vertebral body compression fractures. It was originally developed in France over a decade ago and has been performed in the United States for more than five years. It has been used mainly in the treatment of painful osteoporotic compression fractures that are unresponsive to medical therapy. However, vertebroplasty has also been used successfully in the treatment of painful metastases to bone as well as primary bone tumors. As the technique has been refined some physicians have achieved 90% partial or complete pain relief in their treated patients. The procedure is not useful in the treatment of other causes of back pain such as disc bulges, disc herniations, degenerative spinal disease, spinal stenosis, or nerve root compression. You should consult your physician regarding treatment for these conditions.

Who Should Have A Vertebroplasty?
People suffering from advanced osteoporosis with severe back pain should consult their physician regarding imaging and treatment options. Their pain may be due to an osteoporotic compression fracture and not a disc herniation. In the United States alone, more than 700,000 vertebral body fractures are diagnosed each year in about 10 million osteoporotic patients, resulting in more than 100,000 hospital admissions. These fractures are associated with an almost 15% increased risk of death within five years. With an aging population, the number of patients with osteoporosis is expected to increase significantly in the coming years.

Imaging such as bone densitometry, x-ray, MRI, or CT may be performed prior to your consultation with the interventional radiologist.

How is This Procedure Done?
Vertebroplasty is a procedure performed by radiologists (usually a radiologist specializing in interventional radiology or neuroradiology) in a sterile interventional radiology (fluoroscopy) suite. This allows precise anatomic localization of the spine, something not achievable in even the most modern of operating rooms. After a thorough workup by your interventional radiologist, including blood tests and imaging (x-rays, bone scan, CT scan, or MRI scan), a patient may - in consultation with his/her primary physician - elect to undergo the procedure. Vertebroplasty is generally performed with local anesthesia and intravenous sedation by an anesthesiologist. Prophylactic antibiotics may also be administered before or during the procedure. Monitors are then connected to the patient to assess heart rate, blood pressure, and oxygenation. The patient lies on his/her stomach and the skin is washed with antiseptic solution and covered with a sterile drape. Using x-ray guidance, a needle is carefully placed through the skin in the back into the collapsed vertebra. If necessary, a biopsy of the bone may be performed at this time by removing tissue.

Next, the radiologist performs a venogram. This is a procedure in which dye is injected through the needle into the bone in order to map the venous drainage of the spine and ensure adequate positioning of the needle. Once the needle is properly positioned, polymethylmethacrylate (PMMA), also called "bone cement," is slowly injected into the spine using x-ray guidance. Usually, less than 5 cc of cement is necessary to fill the vertebrae* (Figure 1). The needle is then removed, and if necessary the procedure may be repeated at other spinal levels.

How Long Does This Procedure Take?
On average, the technique takes about one hour for each vertebra treated. Because the cement hardens almost immediately, most patients are able to leave the hospital on the day of the procedure. The patient is usually kept lying flat for two hours and then allowed to sit and walk. The patient is discharged with analgesics for the first 24 hours. Up to 90% of patients report pain relief within 24 hours of the procedure. Most are able to ambulate - pain free - the next day. The treated patient is encouraged to remain as active as possible.

How Do I Prepare For My Procedure?
Patients should not take anything orally but clear liquids after midnight the night before and the morning of your procedure. Please take all of your medicine, including antihypertensives, the night before and the morning of your procedure. Certain blood-thinning medications such as Coumadin (Warfarin), Plavix, and Aspirin should be discontinued prior to the procedure, some as much as a week before; please consult your doctor regarding these medications. Alert your doctor if you have contrast allergy, severe asthma, or are taking medications such as Glucophage (Metformin) prior to the procedure.

Although some people may be discharged the day of the procedure, some may require overnight observation. Plan on arranging a ride home the next day and spending the next twenty-four hours at rest, with no strenuous exercise or bathing for two days.

Am I At Risk For Vertebral Compression Fractures?
Over 80% of people with osteoporosis are female. Other risk factors include age, sedentary lifestyle, tobacco use, medications such as Lasix and Dilantin, and family history. Postmenopausal women are at increased risk due to declining estrogen levels.

Can I Prevent Vertebral Compression Fractures?
Preventative measures include a diet rich in calcium, weight-bearing exercise, avoiding smoking, and bone density testing and medication when appropriate. Consult your physician.