Vertebral compression fracture/ Vertebroplasty:
A vertebral compression fracture occurs when the bones of the spine become broken due to trauma. Usually the trauma necessary to break the bones of the spine is quite large.
In certain circumstances, however, such as in elderly people and in people with cancer,
these same bones can break with little or no force. The vertebrae most commonly broken are those in the lower back.
For patients with vertebral compression fractures due to osteoporosis, metastatic tumors, or benign tumors such as vertebral heamangiomas. Patients with metastasis and myeloma usually experience severe pain and disability.
Vertebroplasty is performed to provide pain relief and to produce bone strengthening and vertebral stabilization when the lesion threatens the stability of the spine.
Radiation therapy may be performed in conjunction with vertebroplasty. When the latter is performed for tumor lesions bone cement injection does not prevent tumor growths. Also radiation therapy does not interfere with the mechanical properties of bone cement and complements.
Vertebral hemangiomas are common benign lesions of the spine that are often asymptomatic and discovered incidentally during radiologic evaluation. Rarely, they may be painful, and there must be a close correlation between clinical findings and radiologic features to ensure that the patient’s pain is due to the vertebral hemangioma. In such cases, vertebroplasty is performed to provide pain relief. The PMMA(cement) is injected for pain relief, bone strengthening, and direct embolization of the hemangiomatous body.
Vertebral fractures are the most common complication of osteoporosis. Age-related
osteoporotic com¬pression fractures occur in more than 500,000 patients per year in the United States. About 15% of women in the United States older than 50 years of age will suffer one or more vertebra compression fractures related to osteoporosis.
- Patients most likely to benefit from vertebroplasty are those with a focal, intense, deep pain associated with evidence of a new or progressive compression fracture.
- Patients who seem to respond the best include those with a single level or a few levels for treatment, fractures that are present less than 2 months or a recent worsening of the fracture, and no significant sclerosis of the fractured vertebra. It should also be determined if the patient is able to tolerate lying prone for 1 to 2 hours.
Computed tomographic (CT) imaging for the diameter of the pedicles to be entered is helpful. Recent plain radiographs should be examined.
Recent MRI should be available, particularly a T2-weighted sagittal image and axial views through the levels of pathology to be treated.
In patients with multiple compression fractures, those vertebral bodies with enhancement demonstrate edema at that level and a greater likelihood of response.
Prothrombin time, partial thromboplastin time & platelet function studies.
The procedure is done under conscious sedation. Sedative analgesics like fentanyl, midazolam, or propofol are administered. Prior to the start of the procedure, a prophylactic antibiotic should be given intravenously.
Vertebroplasty is a percutaneous procedure with a low complication rate that provides immediate and long-term pain relief to patients suffering from chronic vertebral compression fracture pain.
Vertebroplasty is a minimally invasive procedure that not only provides immediate relief but continued and prolonged relief that may increase the patient’s daily activity level, which in turn helps provide a better quality of life. In several studies it has been shown that in more than 90% cases it provides immediate pain relief.