Vertebroplasty may be a recommended procedure for patients who have gone through destabilizing compression fractures in their spine. In many cases, these fractures are a result of deteriorating bone health, or as a secondary symptom of a nearby tumor.
During a vertebroplasty, a doctor utilizes biocompatible bone cement to reinforce and stabilize the fractured region in the spine and reduce the potential of severe spinal deformation or further injuries and pain. This cement is applied to the area via injection.
What is a Vertebroplasty?
Vertebroplasty is what doctors call a minimally invasive, outpatient procedure: there is no need for an overnight stay for observation or recovery, and there is no need to make a major surgical incision of any kind.
The entire surgery involves injections. First, an injection is made to introduce a fluid into the body that would help imaging technology better capture the target area, in a procedure called fluoroscopy. Another injection will be used to anesthetize the target area, and the final guided injection is used, alongside imaging technology, to introduce the pre-mixed bone cement mixture into the destabilized vertebra.
Indications for a Vertebroplasty
In most cases, vertebroplasty is indicated by compromised structural integrity in the spine following a vertebral compression fracture (VCF) caused by osteoporosis or cancer. Not every VCF calls for vertebroplasty. In general, a doctor must determine whether vertebroplasty will help improve the structural stability of a patient’s spine, or whether their fracture has already stabilized.
The vertebrae are the backbones that make up the spine, numbering a total of 33. 7 make up the neck portion of the spine, 12 make up the upper back portion of the spine, 5 make up the lower back portion of the spine, and 5 are found in your hips. The last 4 make up the coccyx or your tailbone.
Flexibility and absorption within the spine
While some bones do not articulate/move, like those in the hips and your tailbone, the majority of the spine is segmented, with spongy discs dividing each vertebra along the entire length of the spinal column. Whereas the vertebrae provide rigidity and structure, the discs allow for flexibility and force absorption within the spine. We can bend over, twist, move weight, and flex and extend our spinal column thanks to these discs.
But if our vertebrae lose rigidity, the structural integrity of the spine is undermined. Like a building with stacked floors, if all the load-bearing pillars are pulverized, the spine can drop. In this case, a vertebral compression fracture can cause a person to lose height and structural stability in the spine.
Wedge & Crush
However, most vertebrae do not fracture equally all throughout. Our backbones are not just a cylindrical disc shape but are made of multiple anatomical parts, including bony protrusions such as spinal facets, and the spinous and transverse processes. Most vertebrae fracture more in one spot than in another.
This causes a fractured backbone to become a wedge, rather than a proportioned load-bearing body. This wedge can deform the entire rest of the spine, causing significant kyphosis (excessive forward rounding of the back) and height loss in many cases. If the backbone does fracture throughout, it is called a crush fracture. After healing, this can result in a vertebra that is shorter/flatter than others.
One of the difficulties of determining eligibility for vertebroplasty is that it can be difficult to determine a VCF until it has significantly advanced. On their own, compound fractures in the spine are often asymptomatic.
Most symptoms only begin to occur because of back pain due to spinal deformity, spinal instability, or nerve compression, of the surrounding spinal nerves. Depending on which vertebra was affected, this can lead to symptoms of pain, tingling, loss of strength, and loss of coordination in the arms, legs, bladder, or bowels. Nerve compression may be a reason not to perform vertebroplasty, until the compromised spinal canal and compressed nerves are addressed.
Once a VCF occurs, vertebroplasty may help improve stability and prevent a dangerous spinal deformity, but it is only part of a larger treatment plan. An osteopathic doctor’s goal in addressing a VCF may include pain management, improving bone density, back bracing, and physical therapy. As mentioned later, there are also reasons not to perform vertebroplasty.
Vertebroplasty vs. Kyphoplasty
Vertebroplasty is usually used in cases of recognized VCF where excessive kyphosis is being prevented. In cases where a patient has already begun to experience excessive rounding, kyphoplasty may be suggested to return the vertebra to its normal height and position.
The only difference between kyphoplasty and vertebroplasty is that kyphoplasty includes the use of a medical balloon, which is injected with bone cement, expanding the fractured vertebra, and turning the wedge back into a normal-shaped backbone.
The process is the same either way. With or without bone cement, a fractured vertebra eventually heals. If it heals without treatment, it may be much more likely to refracture the next time the patient has an accident, lifts something too heavy, or even goes into a coughing fit. Vertebroplasty and kyphoplasty reduce the likelihood of recurring fractures by strengthening and fortifying the fractured bone with cement.
This cement is usually the same kind used in dental procedures. It is a polymer known industrially as plexiglass, full name polymethyl methacrylate (or acrylic). While it is called cement, this is just because it is stored as two separate agents and gets mixed together shortly before injection, at which point it begins to rapidly harden.
It effectively acts as a biological grout, filling in the gaps between your bone fragments to avoid another break. There are other types of bone cement, including calcium phosphate cement (CPCs) and glass polyalkenoate cement (GPCs).
Both vertebroplasty and kyphoplasty procedures are outpatient procedures, so patients can be home the very same day. A doctor will usually keep their patient in observation for about two hours to ensure that they do not develop any immediate signs of post-surgical pain, infection, or cement leakage. The injection site must be kept dry for 24 hours after the procedure.
The patient should avoid driving and operating other heavy machinery for up to two weeks depending on the severity of their fracture. A back brace may also be temporarily provided to limit the spine’s mobility and allow the cement to harden the bone safely.
As with any other procedure, there are also contraindications. These include a recent spinal infection, a recent stroke or heart attack, lack of any pain or negative symptoms following a crush fracture, any conditions that rule out anesthesia, or fractured vertebrae that have been compromised to the point of causing nerve pain.
A doctor will ultimately determine the viability of vertebroplasty or any other procedure through a thorough examination of your imaging and medical history. If you are considering vertebroplasty or kyphoplasty, consult your doctor for a more thorough explanation of how it might benefit your case.
Contact PMIR today to learn more about the Vertebroplasty recovery.