Vertebroplasty is a new, minimally invasive procedure that helps relieve pain associated with compression fractures of the spine. In most cases this treatment diminishes or completely eliminates the patient's pain.
Vertebral compression fractures are a major public health problem affecting the elderly, especially women. Osteoporosis is the leading cause of compression fractures, affecting nearly 10 million people in the United States per year, leading to 700,000 vertebral compression fractures. It is estimated that approximately one-third of women over age 65 will suffer from a painful compression fracture. Other causes of compression fractures include trauma, long term steroid use, angiomas and metastatic disease. Current treatment options are limited, often only to pain management. Surgery is rarely a consideration.
Vertebral compression fractures often occur spontaneously. Patients present with chronic, intractable pain, limited movement, often inability to walk, restricted activity of daily living, loss of height, all which lead to depression. Immobility in the elderly is a harbinger of risk, including respiratory insufficiency, pneumonia, integumentary break down, cardiovascular insufficiency, deep venous thrombosis and pulmonary embolism, to name a few. Pain medications in the elderly can lead to change in affect, increased propensity for falls and addiction.
How The Test Is Performed
Prior to the procedure, patients meet with the physician and his nurse practitioner. A bone scan and MRI confirm the number and degree of compression fractures and if the fractures are active. The day of the procedure, patientís report to the short stay unit of the hospital and are prepared by insertion of an IV for access for conscious sedation. Coagulation studies are checked. The procedure is performed in the angiography suite. Using fluoroscopic guidance, the physician localizes the fracture and performs a percutaneous puncture of the vertebrae via a transpedicular approach. Once the needle is in place, he mixes the PMMA with barium and an antibiotic. The cement is FDA approved and has been used since the 1970ís in orthopedic surgery. The PMMA consistency is like slurry while it is injected, but hardens rapidly. Direct visualization of the cement into the bone allows the physician to monitor the amount and the location of the injectate. The fracture is stabilized by the PMMA and prevents further collapse. Each fracture takes less than an hour to treat, and two levels can be treated at one setting. Patients often report an immediate relief of their pain. Patients are discharged home after four hours.
Nothing to eat or drink after midnight on the day before the procedure.
Inform The Technologist If:
If patient is currently taking blood thinners.
30 - 45 minutes for the treatment of one vertebral body.
After Your Exam:
Patients are usually discharged 3-4 hours after the procedure.
Information regarding the procedure is forwarded to the patient's referring physician.
For more information on Vertebroplasty please see "Cement for Bones Shores Up Spines" in the June 25, 2000 issue of the St. Petersburg Times.