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Bed rest and strong pain medicine are no longer the only treatments for back pain caused by compression fractures of the spine. Now there is a breakthrough minimally invasive medical procedure called percutaneous vertebroplasty that uses bone cement to fill in the spaces of a broken or crushed vertebra.
Vertebroplasty is a pain treatment for vertebral compression fractures that fail to respond to conventional medical therapy, such as minimal or no pain relief with analgesics or narcotic doses that are intolerable. Vertebroplasty stabilizes the collapsed vertebra with the injection of medical-grade bone cement into the spine. This reduces pain, and can prevent further collapse of the vertebra, thereby preventing the height loss and spine curvature commonly seen as a result of osteoporosis. Vertebroplasty dramatically improves back pain within hours of the procedure, provides long-term pain relief and has a low complication rate, as demonstrated in multiple studies. Percutaneous vertebroplasty strengthens the treated vertebra and gives pain relief in most patients. The term “percutaneous” means injecting a fluid through a needle. “Plasty” means to mold or form. Thus, vertebroplasty helps mold the vertebrae by injecting a fluid into the bone. In this case, the doctor injects a bone cement mixture of polymethylmethacrylate (the same cement used in joint replacement surgery), barium or tantalum powder (makes the cement visible on X-ray), an antibiotic, and a solvent into the vertebral body. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast. Vertebrae are bones that form a flexible column to protect the spinal cord. A compression fracture occurs when a vertebra breaks or is crushed. When this happens, a person can feel extreme pain that may last a lifetime. Often the pain keeps the person from performing normal activities. Certain cancers, benign tumors, or osteoporosis of the spine can cause compression fractures.
Factors that increase the likelihood of developing osteoporosis include:
Bone tumors and metastatic bone disease also lead to vertebral compression fractures. Diseases such as multiple myeloma and hemangioma (types of tumors) place patients at great risk for these painful fractures. High doses of steroids for the control of auto-immune diseases such as lupus and rheumatoid arthritis, as well as asthma or chronic pulmonary disease can also increase the risk of reduced bone mass and resulting fractures.
Percutaneous vertebroplasty may be done either as an inpatient or outpatient procedure, depending upon the severity of the fracture and the health of the patient. After suitable sedation is given, a needle is placed into the affected vertebra and fills the damaged area with bone cement.
In many patients, the pain is lessened or even gone within 24 hours. There are few side effects or problems. In some cases, increased pain and fever may occur for a short time. This is treated with anti-inflammatory drugs. Other risks to the patient include infection and allergic reactions to x-ray dye or other medications. There is a very small risk that the cement could leak into areas outside of the vertebra at the time of the procedure, causing spinal cord or nerve damage. If leakage occurs, surgery could be required and the patient could have permanent nerve and organ injury. Pre-Operative Preparation For proper and thorough treatment, review your current medical history with your physician. Your physician may ask you to modify your current medication schedule. Be sure to tell your physician if you are taking blood thinners or have a history of a bleeding disorder, or if you are allergic to any medications, or if you have an infection in any part of your body
Rest well the night before the procedure. It is routine for patients undergoing outpatient surgery to be asked not to eat the night before the procedure. Due to the sedative medications given during the procedure, you will probably be asked to arrange to have someone drive you to and from the medical facility.
If you are on Coumadin, Heparin, Plavix or any other blood thinners (including Aspirin), or the diabetic medication Glucophage you must notify this office so the timing of these medications can be explained. You will either be at clinic facility or hospital for approximately 2-3 hours for your procedure. You will need to bring a driver with you.
You must lay flat after the procedure. You will need to follow-up in the clinic after five to ten days.
Keep the area clean and dry to help prevent skin infection. Do not do any heavy lifting for 3 months (i.e. nothing heavier than a carton of milk). After that, you can gradually increase your lifting to normal. Walking is encouraged and you can bend within the restrictions of your brace.
You may experience some muscle discomfort where the needles were placed. This may be treated with a mild pain reliever such as Tylenol. Do not drive for the remainder of the day. Please have an adult drive you home or accompany you in a taxi or other public transportation. Depending on how you feel, you may resume normal activities and return to work the next day.