Vertebroplasty

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1. Osteoporotic fractures of the vertebral bodies
   The cause of osteoporotic fractures is the reduction of bone mass and the disturbance of the correct architecture of the bone tissue. As a result of the weakening of the mechanical strength of the vertebra, the shaft collapses and becomes wedged under the load. Often a fracture occurs without injury in the course of normal daily activities.
   Symptoms of osteoporotic vertebral fractures are spine pain, reduced body height, and deepening of the thoracic kyphosis. Spine pain is characterized by its location at the fracture level with possible symmetrical radiation towards the abdominal cavity. Pain worsens with prolonged sitting and standing, when moving and carrying heavier objects. Osteoporotic fractures often occur in postmenopausal women, which is associated with a reduction in the level of estrogen that stimulates bone formation.
   Read more about the causes and treatment of osteoporosis.
2. Aggressive vertebral hemangiomas causing pain
   Hemangioma is an expression of arterial vascular growth within the vertebral body. Secondarily, bone tissue is lost to the benefit of the developing vascular network. Most small hemangiomas do not cause pain. In some cases, the large size of the hemangioma or its unfavorable location can cause pain.
3. Paget's disease
   The essence of Paget's disease is the excessive activity of osteoclasts that break down the bone tissue, resulting in excessive bone destruction and weakening of its mechanical strength.
4. Congenital fragility of bones (ostegenesis imperfecta)
   Congenital fragility is a genetically determined disease. Disturbances in the proper structure of collagen, which is a component of bone tissue, lead to pathological fractures.
5. Multiple myeloma
   Multiple myeloma is a cancer of the hematopoietic system in the course of which osteoporotic changes in the bones occur.
6. Some tumor metastases to the vertebrae
   Vertebroplasty helps to relieve pain resulting from metastases of neoplastic vertebrae. It should be noted that this procedure does not cure the primary neoplastic disease (the effect of vertebroplasty is only symptomatic).

What does vertebroplasty surgery look like?

Vertebroplasty is performed under local anesthesia or general anesthesia. During the procedure, the patient is lying on his stomach. The surgeon inserts a needle 2-3 mm thick into the vertebral body - this procedure requires monitoring the needle position with fluoroscopy (X-ray preview). The surgeon then injects liquid cement into the vertebrae to fill the cavities and strengthen the structure of its shaft. The most commonly used cementitious material are two-component acrylic polymers (PMMA - polymethylmethacrylic). Some neurosurgeons also administer a contrast agent, which makes it possible to observe the filling of the vertebra with cement and to visualize any leakage beyond its limits.Vertebroplasty can be performed on the shafts of several vertebrae of the spine at the same time. It takes about 20-30 minutes to fill the body of one vertebra. Until the cement is fully hardened, the patient remains in the supine position (usually no longer than 2-3 hours). After obtaining the proper cement cohesion and obtaining the consent of the physician, the patient can stand up and start walking. Discharge from hospital usually takes place on the second day after vertebroplasty.

Return to daily activities

Most patients experience relief from back pain a few hours after vertebroplasty. Within a few days of the procedure, the injection site may be slightly palpable. A sparing lifestyle is recommended for the first 4 weeks after the treatment. Returning to daily activities should be gradual and take place under the supervision of a doctor and a physiotherapist.

Contraindications

Vertebroplasty is not performed in the case of asymptomatic forms of osteoporosis (vertebroplasty is not used to prevent vertebral fractures). The absolute contraindications include:

damage to the back wall of the vertebral body,
compression of the core at the level of the broken vertebra,
reduction of the height of the shaft above 90% of the original value,
general contraindications (e.g. blood clotting disorders, infections in the spine and skin at the injection site)
pregnancy - due to the need to use X-rays during the procedure,
allergy to acrylic polymers.

 Benefits of vertebroplasty surgery

Performing vertebroplasty allows most patients to achieve a good treatment result in terms of pain reduction and allowing them to resume their daily activities. The effects of the treatment allow you to reduce the dose of painkillers used, and in some cases even give up taking them.

Source:

1. Jay, Bryan, and Sun Ho Ahn. “Vertebroplasty.” Seminars in Interventional Radiology 30.3 (2013): 297–306.
2. Przybyłko N. Kocur D. Sordy R et al. Wertebroplastyka w złamaniach kompresyjnych trzonów kręgów – przegląd piśmiennictwa. Ann. Acad. Med. Siles. 2014, 68, 5, 375–379. 

Important information

Frequently asked questions about vertebroplasty: