Vertebroplasty

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Overview

Osteoporosis is a major health problem throughout the United States and the developed world. In the United States alone, more than 700,000 vertebral body fractures are diagnosed yearly, resulting in more than 100,000 hospital admissions. With an aging population, the number of osteoporotic fractures is expected to increase significantly in the coming years.

Most people with compressive spinal fractures experience pain. This typically lasts 4 to 6 weeks in duration and may leave the patient bedridden and at risk for pneumonia and deep venous thrombosis (blood clots of the legs). In the past, with no adequate treatment for these types of spinal fractures, doctors have primarily focused on hormonal replacement for osteoporosis and analgesics (pain killers) for relief of pain. However, a relatively new procedure known as vertebroplasty promises dramatic relief from painful vertebral body compression fractures.

Vertebroplasty is not really a new technique. It has been performed in the United States for about 17 years. It has been used mainly in the treatment of painful osteoporotic compression fractures that are unresponsive to medical therapy. However, it has also been successful in the treatment of painful primary bone tumors, such as hemangiomata, myeloma, and lymphoma, as well as metastases to the spine. The procedure is not useful in the treatment of disc bulges, disc herniations, degenerative spinal disease, spinal stenosis, or nerve root compression.

Vertebroplasty is a procedure usually performed by a radiologist specializing in neuroradiology or interventional radiology in an x-ray department. After a thorough workup, including blood tests and imaging tests (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. Prophylactic antibiotics may also be administered before or during the procedure. The patient lies on his/her stomach, monitors are connected to assess heart rate, blood pressure, and oxygenation. The skin is washed with antiseptic solution and covered with sterile towels. Using x-ray guidance, a needle is carefully placed through the skin in the back into the affected vertebra in the spine. If necessary, a biopsy of the bone may be performed at this time by removing tissue for laboratory analysis. Next, most radiologists perform a venogram.

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

On average, the technique takes about one hour for each vertebra injected. Because the cement hardens almost immediately, most patients are able to leave the hospital on the day of the procedure. Up to 90% of patients report pain relief within 24 hours of the procedure and consequently greater independence and reduced need for analgesics.

Alan Holz, M.D.
Assistant Professor of Radiology
The University of Miami School of Medicine

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