Vertebroplasty

PATIENT SELECTION
Vertebroplasty is performed for patients with intractable pain due to compression fractures of the spine.  The pain must be lifestyle limiting or require regular narcotic pain control.  The pain often keeps patients awake at night.  The goal of vertebroplasty is to eliminate pain or decrease it to a tolerable level and to restore ability to perform activities of daily living.  Fractures from the upper thoracic spine to the lower lumbar spine and sacrum can be treated.  Patients must not have clinical signs of compression of the nerves or spinal cord related to the compression fracture.

PRE-PROCEDURE WORKUP
Patients who are candidates for vertebroplasty are evaluated in our clinic by an interventional radiologist.  We obtain MRI scans pre-procedurally on all patients to insure that the symptoms can be attributed to compression fractures and not another disease process.  MRI also excludes the possibility of compression of nerves or the spinal cord due to the fracture.  MRI also helps determine which compression fractures are likely to improve symptomatically after vertebroplasty.  The spinal canal must not be compromised by more than 15%.

POTENTIAL RISKS
We discuss in detail with the patient potential risks and alternatives to the procedure.  Risks include (but are not limited to) infection, bleeding, nerve or spinal cord injury, rib fractures and pulmonary embolism.  The incidence of serious complications is approximately 0.5%.  10% of patients do not achieve symptomatic improvement.

DAY OF PROCEDURE
On the day of the procedure, the patient is admitted through our access center and is taken to the pre-operative holding area.  Intravenous antibiotics are administered and standard blood tests are performed.  The procedure is performed in an operating room with special x-ray imaging equipment.  The staff consists of the interventional radiologist, a scrub nurse, a circulating nurse, a sedation nurse and two x-ray technologists.  Local anesthesia and light sedation are administered.  Needles are placed into each side of the vertebra under continuous x-ray visualization.  Once in good position, synthetic cement is injected through the needles.  The cement hardens within one hour.  Up to three compression fractures can be treated at one sitting.  Throughout the procedure the patient's family is informed of the progress of the procedure by our nurse liaison.

POST-PROCEDURE
Following vertebroplasty, patients often achieve immediate symptomatic relief although they are tender at the needle puncture sites. Most patients can be dismissed from the hospital the same day.  Activity is limited to only activities of daily living.  No strenuous activities are recommended as patients are at high risk for additional compression fractures.  Patients may go up and down stairs.  We recommend physical therapy for one week following the procedure to help patients to gradually increase their activities.