1. What is it? Any common name for this procedure?
Vertebroplasty is a minimally invasive image-guided procedure used to treat painful vertebral compression fractures (VCFs). During the procedure, a physician injects a special medical-grade bone cement (polymethylmethacrylate or PMMA) directly into the fractured vertebra. The cement hardens quickly, acting as an "internal cast" to stabilize the bone and alleviate pain.
While it is very similar to Kyphoplasty, Vertebroplasty is a simpler version that does not use a balloon to create space or restore height; the cement is simply filled into the existing crevices of the fracture.
Common Names:
- Percutaneous Vertebroplasty (PVP)
- Spinal Cementing
- Vertebral Augmentation
2. Common Indications: When is it Recommended?
Vertebroplasty is primarily used when conservative treatments fail to manage the pain of a fresh fracture.
- Osteoporotic Compression Fractures: The most frequent cause, occurring when bones become brittle and collapse under minor stress.
- Painful Hemangiomas: Benign, blood-vessel-rich tumors that can weaken the vertebral body.
- Multiple Myeloma/Metastatic Cancer: Stabilization of bones weakened by cancerous lesions to prevent further collapse.
- Recent Traumatic Fractures: Fractures in older patients where bracing is not well-tolerated.
3. List of Associated Diseases and Conditions
- Osteoporosis: The primary systemic disease leading to vertebral collapse.
- Kyphosis: The "dowager's hump" or forward-leaning posture that results from multiple compression fractures.
- Lytic Lesions: Areas of bone destruction caused by cancers that make the spine prone to "pathological" fractures.
4. List of Screening Tests and Assessment Tools
Before cementing, it is vital to prove that the fracture is the actual source of the pain.
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Tool
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Purpose
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MRI (STIR Sequence)
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Critical. This sequence shows "bone edema" (swelling). If the bone is bright white on a STIR scan, it is "active" and will respond to the cement.
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CT Scan
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Used to ensure the back wall of the vertebra is intact. If the wall is broken, cement could leak into the spinal canal.
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Bone Scan (Scintigraphy)
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Used if a patient cannot have an MRI; it highlights areas of high bone turnover/healing.
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Physical Exam
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"Point tenderness"—pain directly over the bone when touched—is a key indicator for success.
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5. Am I Eligible for This Evaluation?
Failure of Medical Management: You have tried 2–4 weeks of pain medication, rest, and bracing without significant improvement.
- Acute Nature: The fracture should ideally be "fresh" (less than 3–4 months old). Once a bone has fully healed in a collapsed position, the cement cannot offer much relief.
- Localized Pain: The pain must be mechanical—meaning it gets worse when you move, walk, or stand, and is located exactly where the fracture is.
- Stable Fracture: This is not for "burst" fractures where the bone fragments are already pressing on the spinal cord.
6. Pre and Post Care
Pre-Care:
- Blood Work: Checking for infection (WBC count) and ensuring your blood clots normally.
- Sedation: Usually performed under "conscious sedation" (twilight sleep) so you are comfortable but can still communicate with the doctor.
Post-Care:
- Flat Rest: You must lie flat on your back for 1 to 2 hours immediately after the procedure while the cement reaches full hardness.
- Wound Care: Only a tiny puncture remains; no stitches are needed. Keep the bandage dry for 24 hours.
- The "Next Step": It is essential to treat the underlying osteoporosis (with Vitamin D, Calcium, or bone-building medications) to prevent a "domino effect" of fractures in nearby vertebrae.
7. Days Required for Hospitalization
- Surgical Time: 30 to 60 minutes per level.
- In-Hospital Stay: 0 Days. This is almost always an outpatient procedure.
- Pain Relief: Many patients feel a 50–90% reduction in pain within the first 24 to 48 hours.
- Hospitalization: 0 Days.
8. Benefits of Vertebroplasty
- Rapid Mobility: By stabilizing the fracture, patients can often stop bed rest and return to walking almost immediately, which prevents complications like pneumonia or blood clots.
- Reduced Medication: It often eliminates the need for heavy opioids and narcotics, which can cause falls and confusion in elderly patients.
- High Success Rate: For properly selected patients (those with "active" fractures on MRI), the success rate for significant pain relief is approximately 80% to 90%.
