People who suffer from painful compression fractures of the spine related to
loss of bone mineral (osteoporosis) and other causes (cancer, trauma) may
find relief with a new procedure being offered by Greenville Radiology.
Vertebral Body (Spinal) Compression Fractures:
Osteoporosis, or brittle bone disease, affects 10 million people in the
United States and each year leads to 700,000 painful spinal vertebral
compression fractures (collapse of the weakened bone), according to the
National Osteoporosis Foundation. Although in most people the fracture heals
on its own and the pain goes away, in others pain persists, most likely
because the crushed bone doesn't fully heal and continues to move. Surgery
is frequently not an option, because the screws and hardware typically used
in spine surgery will not hold in the brittle bone.
What is Vertebroplasty?
A new technique called percutaneous vertebroplasty (ver-TEE-bro-plasty),
offers hope to people who previously have had few options other than spinal
bracing and narcotics and other painkillers. Vertebroplasty involves
injecting medical cement into the fragile fracture site. It will harden and
permanently stabilize the fracture, thereby improving or relieving back
pain. Most patients treated will have complete or significant reduction of
their pain with vertebroplasty. The procedure is generally safe, with few
risks. The potential complications and risks of the procedure should be
discussed with your doctor.
Prior to the procedure, radiologists use X-rays, magnetic resonance imaging
(MRI) and bone scans to find the fracture or fractures that are causing the
pain, and to rule out other causes of pain that may not be treatable with
this technique. When the area is located and confirmed, a neuroradiologist
injects bone cement into the vertebra under X-ray guidance using a hollow
needle. The procedure takes one to two hours and typically is performed with
local anesthesia. Occasionally, general anesthesia may be necessary. The
bone cement hardens within 15 minutes and the patient remains at bed rest
for several hours. The procedure can be performed on an outpatient basis.
The Procedure
Upon arrival into the suite, you will be placed onto your stomach for the
procedure. Your arms will be put into the “superman” position (arms straight
out, next to and over your head). A nurse will be giving you medications
through an intravenous line to sedate and relax you. You will also be
connected to an EKG machine to monitor your heart rate and rhythm, blood
pressure and oxygenation continuously. You will hear the technologist, nurse
and doctors setting up the equipment/supplies for the procedure and they
will talk to you at various points along the way to tell you what is going
on. You will need to be very still. It is important that you try your best
to be still. Occasionally, general anesthesia may be required. This will
improve the results of the x-ray images and minimize the length of your
procedure.
The skin on your back, overlying the fractured vertebrae to be treated will
be washed with special soap and then draped with sterile sheets and towels.
This area will be anesthetized with numbing medication and a special needle
is then advanced into the affected vertebrae under fluoroscopic (x-ray)
guidance. When the needle tip is in position, an injection of contrast (dye)
is performed to provide the doctors with a blood vessel map and make sure
there are no abnormal blood vessel connections. This insures correct needle
placement prior to injecting the cement. Once the correct placement of the
needle is confirmed, treatment may begin.
First, a medical cement is mixed together with a material that shows up on
xray(contrast). This allows the doctors to see the mixture actively going
into the bone on the x-ray screens. Secondly, an antibiotic may be added to
the mixture to reduce the risk of infection. As soon as the cement and all
of the ingredients are mixed together, it forms a liquid mixture. This
mixture now begins to harden rapidly, so the doctors must work quickly and
efficiently. When enough of the cement is injected into the damaged bone, as
seen on the x-ray, the needle is removed and gentle pressure is applied over
the puncture site. No stitches are required and you are left only with a
band-aid.
The procedure will take one to several hours, depending on the number of
segments to be treated, as well as on the type of anesthesia required.
After the Procedure
As soon as the procedure is completed, a CT scan may be performed.. You will
then be transferred onto a stretcher and remain either on your stomach or be
put onto your back for up to four additional hours. This allows complete
curing of the cement prior to standing. You will begin on clear liquids and
quickly advance to your normal diet as tolerated.
The nurse will assist you for your first time up, as you may be tired from
the medications and/or light-headed from being flat for so long.
Most of our patients go home the same day, some as soon as 4 hours after the
procedure is completed. Arrangements for a family member or a friend to
drive you home should be made prior to your discharge. Your activities at
home can be increased as tolerated. Please do not attempt any strenuous
activity at first. Be gradual and use your common sense to guide you. You
may feel so good that you forget you did have a major procedure done. No
heavy lifting is advised for up to one week; e.g., nothing heavier than a
pocket book or a small bag of groceries.
Follow-Up
Depending on the specifics of your condition, you may be referred to a
physical therapist or other rehabilitation services as needed. Also, you may
receive an exercise instruction sheet if your doctor has prescribed such
activities.
Your back pain may be relieved immediately or within a few days. If not, you
are required to be re-evaluated for other possible causes by your referring
physician. There is a possibility that similar pain can occur in a different
location. This indicates that you may have developed another fracture. If
so, you should contact us for further evaluation and treatment.
The cement makes the vertebral body stronger, possibly even stronger than
normal bone, and can prevent further collapse. The procedure generally does
not, however, return the vertebrae to its former size.
The outcome of the procedure in patients has been very encouraging, with the
majority of patients experiencing partial or complete pain relief. This
minimally invasive treatment can give people back their mobility, and
increase the quality of life. We have been performing vertebroplasty at
Greenville Radiology for several years, and most of the patients treated
have had significant or even complete relief of their pain.
Frequently Asked Questions:
Is it safe?
Yes. Thousands of patients have undergone this procedure. Vertebroplasty has
been performed for many years in Europe. The chance of complication is low.
As with any medical procedure, the possibility of complications will depend
on the individual patient. For example, patients with tumors in the spine or
with other serious medical conditions may be at higher risk for
complications from vertebroplasty. You should always ask your doctor to
discuss risks and complications with you before you undergo any procedure.
Is it covered by insurance?
It has been approved by Medicare in South Carolina and it is covered by most
private insurance companies.
What is the recovery time?
It is an outpatient procedure and takes approximately 2 hours, with about a
4 hour recovery. The patient can often be sent home the same day.
Do I have to be put to sleep?
No, the procedure is done using local anesthetic and some light sedation
given intravenously during the procedure.
How long does it take before a result can be expected?
Most patients experience pain relief within the first 48 hours. This
gradually improves over the next few weeks.
How effective is vertebroplasty?
With good patient selection and good technique about 75-90% of the patients
will experience significant pain relief within the first few days after the
procedure.
For more information go to: www.asitn.org
and / or www.scvir.org
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