Why is Vertebroplasty Performed?
Vertebroplasty is a procedure used to repair spinal fractures caused by compromised vertebrae. Osteoporosis, a disorder that causes bones to become weak and brittle, is the most prevalent cause of such fractures. These fractures can be very painful, making it difficult for patients to move around or do daily tasks. In rare situations, the discomfort can be excruciating and incapacitating. Vertebroplasty is a therapeutic option for individuals who have not responded to more conservative therapies including pain medication, bed rest, or physical therapy. Vertebroplasty can help reduce pain and improve mobility in individuals with spinal fractures by anchoring the vertebral body with bone cement.
What Causes Osteoporotic Compression Fractures?
Osteoporosis is most often due to vitamin D deficiency but can be due to more complicated medical conditions such as liver or kidney disease. Compression fractures can also occur in the context of cancer spread to the spine but these can usually be distinguished on an MRI or CT scan.
What Conditions Can Vertebroplasty Treat?
- Osteoporotic vertebral fractures: The most prevalent reason for vertebroplasty is osteoporotic vertebral fractures. Osteoporosis is a disorder that causes bones to become weak and brittle, which can lead to vertebral compression fractures.
- Cancerous spinal fractures: Vertebroplasty can be performed to treat cancerous spinal fractures. These fractures can be very painful and impede a patient's movement.
- Traumatic spinal fractures: Vertebroplasty can be performed to treat trauma-related spinal fractures, such as those produced by a fall or a vehicle accident.
- Vertebral hemangiomas: There are benign tumours that can cause vertebral compression fractures.
- Multiple myeloma: This is a type of cancer that affects the bone marrow and can cause spinal fractures.
- Paget's disease: This is a chronic condition that affects the bones and can cause spinal fractures.
- Spinal tuberculosis: Spinal tuberculosis is an infection that can cause compressive fractures in the spine.
- Metastatic spinal tumors: Vertebroplasty can be done to treat spinal fractures caused by tumours that have spread to the spine from other regions of the body.
In general, vertebroplasty is indicated for painful vertebral compression fractures that have not responded to more conservative treatments such as pain medications, physical therapy, or bed rest.
What Symptoms and Problems Can Vertebroplasty Help Improve?
With a lot of medical issues, there is rarely one treatment and it is a discussion between yourself and your medical specialist as to what treatment is best suited to you. Vertebroplasty should be considered if you are suffering from any of the following:
- Severe and persistent back pain: Pain in the back that is severe, persistent, and does not respond to pain medications or other conservative treatments may be a sign of a vertebral compression fracture that may warrant vertebroplasty.
- Limited mobility: A vertebral compression fracture can cause limited mobility and make it difficult to perform daily activities. If you have trouble walking, standing, or sitting for prolonged periods of time, you may be a candidate for vertebroplasty.
- Kyphosis: A vertebral compression fracture can cause the spine to bend forward, leading to a hunched or rounded back posture. This is known as kyphosis and may warrant vertebroplasty.
- Neurological symptoms: In rare cases, a vertebral compression fracture may compress the spinal cord or nerve roots, leading to neurological symptoms such as numbness, tingling, weakness, or difficulty controlling bladder or bowel function. If you experience these symptoms, seek medical attention immediately.
How Does Vertebroplasty Compare to Other Compression Fracture Treatment Options?
Vertebroplasty is one of several treatment options available for vertebral compression fractures. Here is a comparison of vertebroplasty with other treatment options:
- Conservative treatment: Conservative treatment for vertebral compression fractures may include pain medication, rest, physical therapy, and the use of back braces. While these treatments can provide some pain relief, they may not be effective in severe cases and may take longer to achieve pain relief.
- Kyphoplasty: Kyphoplasty is a similar procedure to vertebroplasty, but it involves the use of a balloon to create space in the compressed vertebra before the injection of bone cement. Studies have shown that kyphoplasty may provide greater pain relief and better restoration of vertebral height compared to vertebroplasty.
- Surgery: In some cases, surgery may be necessary to treat vertebral compression fractures. Surgical options include spinal fusion, laminectomy, and corpectomy. Surgery is generally considered a last resort and is only recommended if other treatments have failed or if the patient is experiencing severe neurological symptoms.
- Medications: Medications such as bisphosphonates and calcitonin may be used to treat osteoporosis and prevent further vertebral compression fractures. However, these medications may take time to be effective and may not provide immediate pain relief.
The choice of treatment for vertebral compression fractures depends on the severity of the fracture, the patient's overall health, and their personal preferences. Your healthcare provider can help you determine the best treatment option for your individual needs.
How is Vertebroplasty Performed?
Here is a step-by-step guide of what to expect during a typical vertebroplasty procedure:
Step 1: Pre-procedure Preparation
Before the treatment, the patient will usually have a physical exam, blood tests, and imaging examinations such as X-rays, CT scans, or MRI scans. They may be given anesthesia, which might be general or conscious sedation.
Step 2: Insertion of Needle
The patient is placed on a radiography table on their stomach or back, and the skin above the afflicted region is cleansed and sterilised. The doctor inserts a needle into the compressed vertebra using X-ray guidance through a tiny incision in the skin.
Step 3: Injection of Bone Cement
After inserting the needle, the doctor injects specific bone cement into the compressed vertebra. Within minutes, the cement solidifies, securing the vertebra and giving instant pain relief.
Step 4: Post-procedure Recovery
Following the surgery, the patient is observed for a brief length of time before being discharged, generally the same day or the next day. They may feel some slight discomfort or pain, which can be relieved with pain medication.
Step 5: Follow-up
A week following the operation, the patient will normally have a follow-up session with their doctor to check that everything went well and to monitor their progress. Patients may also be subjected to further imaging investigations to check the vertebral stability and the location of the cement.
Overall, vertebroplasty is a low-risk operation that can give considerable pain alleviation for individuals suffering from spinal compression fractures. It is widely regarded as safe, with a low chance of problems. However, there are risks and advantages to every medical surgery, and patients should examine their choices with their healthcare practitioner to determine if vertebroplasty is an acceptable therapy for their specific requirements.
How Long Does Treatment Take?
The time required for vertebroplasty varies depending on the number of vertebrae to be treated and the intricacy of the treatment. Nonetheless, the treatment itself takes around an hour per treated vertebra on average. This time period comprises pre-procedure preparation, needle insertion, bone cement injection, and post-procedure recuperation. Patients may usually go home the same day or the next day after the operation. They may need to avoid intense activity for a few days, and they may have minor discomfort or pain for a brief time.
What Can I Expect During Recovery?
Vertebroplasty recovery is often short, with most patients able to resume regular activities within a few days to a week of the treatment. The length of recovery time depends on the patient's overall health, the scope of the treatment, and the location of the treated vertebra.
Patients may suffer slight discomfort or soreness at the location of the injection immediately following the treatment, which can typically be handled with pain medication. They may also feel moderate bruising or swelling around the injection site, which usually goes away after a few days.
Patients are normally recommended to avoid vigourous activity, heavy lifting, or bending for the first several days after the operation. They can usually resume mild activities like walking and light housework within a day or two.
Patients may be recommended to wear a back brace or corset for a short time to support the treated vertebra and limit the risk of additional damage.
Generally, the vertebroplasty recovery process is well-tolerated and has a minimal risk of complications. Patients should, however, carefully follow their doctor's instructions and report any persistent pain, swelling, or other odd symptoms to their healthcare practitioner.
How Long Will I be in The Hospital?
You will stay in the hospital until your pain is improved and your mobility is at a level where you are safe to be discharged. If you are previously well and an outpatient then this may be a short period, for other patients this can take longer. On average, you can expect to stay for up to 90 minutes after the procedure.
What is The Success Rate of Vertebroplasty?
Several studies have been conducted to evaluate the success rate of vertebroplasty in treating vertebral compression fractures. While the exact success rate can vary depending on a number of factors, including the severity of the fracture and the patient's overall health, the overall success rate of vertebroplasty is generally considered to be high.
According to a systematic review and meta-analysis of 16 randomized controlled trials involving a total of 1,789 patients published in the journal Spine in 2018, vertebroplasty was associated with significant pain reduction and improvement in functional outcomes compared to non-surgical treatments such as pain medication and bed rest. The review found that vertebroplasty resulted in a significant reduction in pain scores, as well as improvements in physical function, quality of life, and mobility. The authors of the study reported that the success rate of vertebroplasty was approximately 85% in reducing pain and improving function in patients with vertebral compression fractures.
Another study evaluated the long-term outcomes of vertebroplasty in 141 patients with osteoporotic vertebral compression fractures, found that 86% of patients reported significant pain relief and improvement in daily activities at 6-month follow-up. The study also found that the pain relief and functional improvement achieved with vertebroplasty were sustained over a 5-year follow-up period.
Overall, the available data suggests that vertebroplasty is a safe and effective treatment option for vertebral compression fractures, with a high success rate in reducing pain and improving functional outcomes in the majority of patients. However, as with any medical procedure, the risks and benefits of vertebroplasty should be carefully weighed and discussed with a healthcare provider to determine the most appropriate course of treatment for each individual patient.
Is Vertebroplasty Right For Me?
Many criteria influence whether vertebroplasty is the best therapeutic choice for a patient with spinal compression fractures.
Initially, people who have suffered a spinal compression fracture should be evaluated thoroughly by a healthcare practitioner in order to establish the degree of the fracture and rule out any underlying illnesses that may have contributed to the fracture. Imaging examinations such as X-rays, CT scans, or MRI may be utilised to examine and diagnose the severity of the fracture.
While providing a therapy suggestion, a healthcare expert will examine your general health and medical history, as well as their symptoms and amount of discomfort. In general, vertebroplasty may be a good treatment option for patients who have not responded to more conservative measures such as pain medication, bed rest, and physical therapy.
Individuals who are considering vertebroplasty should talk to their doctor about the risks and advantages of the treatment. While vertebroplasty is usually regarded safe and successful, it does include certain risks, including infection, bleeding, and nerve injury, as with any surgical operation. Some medical disorders or drugs may exclude patients from being ideal candidates for vertebroplasty.
Finally, the choice to have vertebroplasty performed should be made in consultation with a healthcare expert, such as Dr Quigley of Northern Beaches Interventional Radiology. Make an appointment now to review your treatment options and determine whether vertebroplasty is suitable for you.