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Vertebroplasty

By

Sarah Lewis, PharmD

What is vertebroplasty?

A vertebroplasty is a procedure used to treat compression fractures in your spine. Your vertebrae are the bones that make up your spinal column. They surround and protect your spinal cord. When one of your vertebra fractures, it collapses and can narrow the area around your spinal cord. This can lead to pain. In a vertebroplasty, your doctor injects an acrylic cement mixture into the fractured vertebra. The cement mixture fills in and strengthens the fractured vertebra to relieve pain.

A vertebroplasty is a minimally invasive procedure. Your doctor may only consider this procedure if other options with less risk of complications have failed. These may include bed rest, pain medication, back braces, and physical therapy for several weeks without satisfactory back pain relief. Vertebroplasty is most likely to be successful when used within eight weeks after a vertebral compression fracture.

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A vertebroplasty is only one method used to treat a vertebral compression fracture. Discuss all of your different treatment options with your doctor to understand which options are right for you.  

Why is vertebroplasty performed? 

Your doctor may recommend a vertebroplasty to treat vertebral compression fractures in your spine. Vertebral compression fractures occur when your vertebral bones become weak. 

Your doctor may recommend vertebroplasty to treat the following conditions:

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  • Malignant or cancerous fracture. Cancerous tumors can weaken your vertebral bones, putting you at risk for vertebral compression fractures.

  • Osteoporotic fracture. Osteoporosis leads to a loss of bone mass and bones that are porous. This weakens your bones and puts you at risk for vertebral compression fractures.

  • Reinforcement of a vertebral bone or multiple vertebrae before a surgical stabilization procedure

  • Vertebral hemangioma, which is an abnormal overgrowth of blood vessels within a vertebra

  • Vertebral osteonecrosis, which is bone death. Osteonecrosis is a rare condition.

  • Weakened vertebrae when you are too frail or your bones are too weak for open surgical repair

Who performs vertebroplasty?

The following specialists perform vertebroplasty:

  • Neurosurgeons specialize in the surgical treatment of diseases and conditions of the nervous system, including the nerves of the spine.

  • Orthopedic surgeons specialize in surgical treatment of diseases and conditions of the muscles and bones, including the spine.

  • Interventional radiologists and vascular radiologists specialize in diagnosing and treating diseases using radiation and other imaging technologies.

  • Neuroradiologists specialize in diagnosing and treating diseases and conditions of the brain, spine, head, neck and nerves using radiation and other imaging technologies.

The doctor most likely to perform your vertebroplasty is an interventional radiologist.

How is vertebroplasty performed?

Your vertebroplasty will be performed in an outpatient radiology facility or in a hospital. It takes about an hour for one vertebra and generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.

  2. Your imaging team will insert an IV to provide fluids and medications.

  3. Your imaging team will attach devices to monitor your vital signs.

  4. You will receive medication (a moderate sedative) to relax you. If you are in extreme pain from your vertebral compression fracture, you may receive general anesthesia.

  5. You will lie face down to expose your spine. You will receive pillows and supports to provide comfort and help keep you positioned properly.

  6. Your imaging team will shave, clean and cover the affected area of your spine with a surgical drape.

  7. Your radiologist will numb the skin and muscles with an injection of local anesthetic.

  8. Your radiologist will insert a needle through your skin and into your fractured spinal vertebra. Real-time X-rays will guide proper needle placement. During the procedure, your radiologist will ask you questions about your pain.

  9. Once the needle is in place, your radiologist will inject medical-grade cement into your vertebra and then remove the needle. The cement hardens within 15 to 20 minutes.

  10. The radiologist repeats the process for each fractured vertebra.

  11. The imaging team may take additional X-ray images once the injections are complete.

Will I feel pain?

Your comfort and relaxation is important to both you and your care team. You may feel a brief pinch or prick during IV insertion. You may also feel brief stinging during injection of the local anesthetic in the skin of your back. You will have sufficient pain and sedative medications so that you stay comfortable. Tell a member of your healthcare team if you are uncomfortable.

What are the risks and potential complications of vertebroplasty? 

Complications after vertebroplasty are uncommon, but any procedure involves risks and potential complications. Complications can develop during the procedure or your recovery. Risks and potential complications of vertebroplasty include: 

  • Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing

  • Bleeding

  • Cement leakage into your spinal canal where your spinal cord is located

  • Exposure to ionizing radiation, which may be harmful in excessive doses. Your care team follows strict standards for X-ray techniques and will use the lowest amount of radiation possible to make the best images.

  • Increased back pain

  • Infection

  • Nerve or blood vessel damage

  • Paralysis (rare) or weakness

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and: 

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

  • Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my vertebroplasty?

You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome.

You can prepare for a vertebroplasty by:

  • Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Arranging for a ride home

  • Following exactly any instructions about eating and drinking before a vertebroplasty

  • Leaving jewelry, metal objects, credit cards, and other valuables at home

  • Getting all necessary laboratory testing completed prior to your procedure

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Preparing for a vertebroplasty can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need vertebroplasty? Are there any other options for treating my condition?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can I return to work and other activities?

  • What kind of assistance will I need at home? Will I need a ride home?

  • How should I take my medications?

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.