VertebroplastyPatient Information By Dr Eisen Liang
What is vertebroplasty?
Vertebroplasty is a treatment for relieving pain due to vertebral compression fractures. Until recently there has been no active intervention for vertebral fractures. In the past conventional treatment were typically weeks to months of bed rest, analgesia, and sometimes bracing. There is now a minimally invasive non-surgical alternative.
Vertebroplasty is a simple procedure. A radiologist inserts a needle through the skin into the vertebra, guided by X-ray machine. Bone cement is then injected to form an internal splint. The cement reinforces the vertebral body and stabilizes the fracture and thus achieving pain relief.
Vertebroplasty significantly shortens recovery time and hasten rehabilitation care.
Why vertebroplasty?Traditional treatment of vertebral fractures has been bed rest, analgesics orally or by injection, muscle relaxants, external back-bracing, and physiotherapy. Patient may fail to respond to conservative therapy and suffer from prolonged pain and immobility, which can persist for weeks to months.
Prolonged bed rest predisposes to bedsores, pneumonia, clots in the legs and lungs. The pain from vertebral fracture is usually worse when patient try to move and walk.
Prolonged immobility leads to further bone mineral loss, weakens your bone and increases your risk of further fractures. Other complications of vertebral compression fractures include loss of height and kyphosis(bending of spine); respiratory or gastrointestinal disturbances; and emotional and social problems secondary to unremitting pain and loss of independence. Patient may develop adverse effects from high dose analgesia, such as confusion, constipation, respiratory suppression and drug dependency.
It may take only a few days to identify patients who are unresponsive to conservative therapy and have failed to mobilize. These patients are candidates for vertebroplasty.
How is the procedure performed?You will be briefed about the procedure before you give your consent. You will be given an IV sedation and pain relief. The procedure is performed under local anaesthetics in the angiography suite of radiology department. High quality X-ray equipment is essential for accurate placement of the needle and real-time monitoring of the cement injection. You will need to lie on you tummy facing down on the X-ray table. We will then plan the procedure with the X-ray machine. You will then be prepared with antiseptic solution over the needle entry site. One or two bone biopsy needles will be inserted. The bone cement will be prepared and injected slowly under X-ray monitoring. As early as 30 minutes after injection, if you are conscious and alert, you may sit up or even take a test walk.
How effective is vertebroplasty?Comparison study has demonstrated that the procedure is highly effective in pain control. The effect is almost immediate. In the treated group at 24 hours, about one quarter of patients was able to cease analgesia completely and 73% patients were able to cut the analgesia by more than 50%. There was also 50% reduction in pain score and 30% improvement in physical function. This translates to earlier mobilization and return of normal activities, avoiding complications such as DVTs and pneumonia. The mean hospital stay can be reduced by 43%, according to a clinical outcome study.
What are the diagnostic work-ups required?Patient selection is a key factor in the efficacy of this treatment. The treatment is most effective in relieving pain from acute fracture. Some patients have multiple fractures, it is important to know which particular fracture is causing pain. There should be a strong correlation between clinical signs and symptoms, and cross-sectional imaging findings.
MRI is most useful in showing which fracture is recent. When MRI is contraindicated, radionuclide bone scan can be used. However, bone scan can stay hot for months to years after fracture and therefore may not be able to distinguish acute from chronic fractures. CT scan maybe required for procedural planning.
What are the preparations needed?You should not have solid food for 6 hours before the procedure. Clear fluid and medications can be taken until the time of procedure. If you are on blood thinning medications(such as Wafarin, heparin, claxane, plavix; aspirin is fine), you should ask your usual doctors if the they can be safely stopped or dose reduced.
Are there any risks?The risk of the procedure is very low. Cement leakage into the spinal canal may occur but symptomatic permanent neurological deficit is less than 1%. Other complications such as injury of rib or transverse process, cement leakage to lungs and allergic reaction to cement are all report to be less than 1%.
What are the aftercares?If you are conscious and alert, you can sit up 30 min after injection. You may wish to try a test-walk with assistance and under supervision.
You may then return to your ward if you were in-patient. If you were out-patient or patient from another hospital you may be discharged to your carer from us 2 hours after the procedure to allow you recover from the sedation. You should not drive or operate machinery for 24 hours.