Vertebroplasty

I. Introduction
  • Vertebroplasty is a procedure that provides pain relief from a painful vertebral body.
  • This procedure may be performed at any level of the spine, although is most commonly performed in the thoracic and lumbar spine.
  • As opposed to a selective nerve root block, or a facet injection, which target a specific nerve or joint on one side of the spine, Vertebroplasty targets the vertebral body itself.
  • The Vertebroplasty procedure delivers a material commonly referred to as ‘bone cement’ (Polymethylmethacrylate, or PMMA) directly into the vertebral body.
  • Vertebroplasty is typically performed at one level, although can be performed at multiple vertebral body levels.
Percutaneous Vertebroplasty
II. The Vertebral Body
  • The vertebral bodies provide the major structural support for the spine.
  • They lay on top of one another, beginning at the base of the skull (cervical vertebral bodies) and end at the sacrum.
  • Vertebral bodies are very innervated, as are the all bones in the body. This means they have many nerve endings within and mostly around them. When there is an abnormality of the vertebral body, these nerves are irritated, and give the sensation of pain.
III. Back Pain
  • Back pain may arise from any anatomic structure within or around the spine which has nerve endings and is capable of transmitting pain.
  • These structures include vertebral bodies, discs, facet joints, muscle, nerves, ligaments and dura (the membrane lining of spinal canal).
  • All of these structures are very close to one another within the spine.
  • Pain from a vertebral body fracture is typically pain in the back at the level of the fracture, although it can be difficult to diagnose the exact cause of pain. Patients also tend to have pain directly over the site of fracture, which can be palpated (felt) by pushing on the skin of the back over this level.
  • The Vertebroplasty procedure is targeted toward pain caused by a vertebral body compression fracture.
  • A particularly common and perhaps the most common cause of compression fractures of the vertebral bodies in the elderly is osteoporosis.
  • The bone cement works by preventing further collapse, or fracture of the vertebral body.
IV. Patient Selection
  • Back pain affects nearly everyone at some point in their adult life.
  • Oftentimes the exact cause of pain is not readily apparent, as there are many factors which may be contribute to a patient’s back pain, including disc disease, referred pain, as well as psychological factors. This can make the exact site and level responsible for the back pain more challenging to localize and diagnose.
  • Imaging studies (X-RAYs, MRI and CT scans) are very helpful in screening the spine for compression fractures as a possible cause for the patient’s pain.
V. Procedure
  • The procedure is explained to the patient, questions are answered and informed consent is obtained.
  • An intravenous line is place to give a small amount of medication to relax the patient.
  • The patient is placed prone (stomach down) on the fluoroscopic table, and the lower back is sterilely cleansed with povidone-iodine (Betadine) and alcohol.
  • The exact level is located with the fluoroscope, and the skin overlying this area is anesthetized (numbed) with lidocaine. This is in the midline of the back.
  • A needle is then sterilely advanced into each side of the vertebral body.
  • Typically, as small amount of water-soluble contrast (dye) is injected to confirm proper needle tip position.
  • Once this is confirmed, a mixture of bone cement and contrast are injected into each of the two needles.
  • This procedure is performed with Fluoroscopic guidance.

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