The Jury is In: Vertebroplasty Reduces Pain and Improves FunctionDoctors know that anyone over the age of 50 experiencing sharp and sudden mid-to-low back pain could be suffering a vertebral compression fracture (VCF). These fractures of the vertebra can occur without obvious trauma. Osteoporosis (weakened or brittle bones) is the major risk factor. When stress on the spine from everyday movements is greater than the strength of the bone, the bone fractures and collapses down on itself. That's a vertebral compression fracture (VCF).
More and more people are being affected by VCFs every day. In fact, it's estimated that a new VCF occurs every 45 seconds. This adds up when over 10 million people have osteoporosis and the potential for a VCF. And once you've had one VCF, your risk for another one goes up five times.
But there's some good news in all of this. A treatment procedure called vertebroplasty was developed about 15 years ago. A long, thin tube called a cannula (needle) is inserted through the skin into the vertebral bone. Cement is injected through the needle into the compressed area. The cement hardens quickly and stabilizes the fracture.
The surgeon uses a special X-ray imaging called fluoroscopy to guide the needle and ensure accurate placement of the cement. The surgeon is careful to only inject cement into the anterior (front half) of the vertebral body. Every effort is made to avoid cement leaking into the posterior (back) portion of the vertebral body. This is to prevent any cement from getting into the spinal canal where the spinal cord is located.
It doesn't take long for the cement to harden. Then the surgeon removes the needle. Just a simple (sterile) bandage is needed to cover the puncture site(s). The patient remains in the recovery room for a couple of hours while the nurses check to make sure there are no problems or complications.
Studies are showing that percutaneous vertebroplasty works well for the treatment of VCFs. It reduces pain, maintains the height of the vertebral body, and can prevent serious health problems. Some minor soreness or discomfort may be present at the place where the needle was inserted.
But the majority of patients do well. The procedure reduces their back pain and this, in turn, increases their movement and return to daily function. Nine out of 10 patients are able to reduce (or stop) taking pain relievers. By the end of three months, patients can begin to gradually start lifting objects that weigh more than five pounds.
Not everyone can have this procedure. If the fracture is stable and isn't causing any symptoms, the surgeon may adopt a wait-and-see approach. Anyone with cancer causing the vertebral compression fracture and collapse may not be a good candidate. Cement leaks are much more common when the fracture is caused by cancer that has eaten away at the bone. This doesn't mean that cancer patients can't have a vertebroplasty. Vertebroplasty for cancer patients must be evaluated on an individual basis.
Vertebroplasty can't be done if a bone fragment from the fracture has shifted or moved into the spinal canal or is pressing on the spinal cord. And there are some patients who are allergic to the bone cement.
All in all, with good technique, the surgeon can perform a vertebroplasty quickly and easily. The procedure is done when more conservative care (bracing, exercises, medications) is unable to reduce or relieve painful symptoms.
With the help of fluoroscopy, vertebroplasty is a safe procedure. Surgeons are trained in ways to place the needles so that the least amount of bone and tissue are affected. Type of cement, amount of cement, and ways to inject the cement have all been developed and improved since this procedure was first introduced.
Paul J. Lynch, MD, DABA, and Nicole E. Berardoni, MD. Pecutaneous Vertebroplasty: An Effective Intervention for the Treatment of Vertebral Compression Fractures. In Pain Medicine News. December 2008. Vol. 6. No. 9. Pp. 85-92.
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