What
is a Vertebroplasty?
The spine is made up of bones called vertebrae that are linked
together. When these bones become weakened , one or more can break
and start to flatten out. This is known as a compression fracture.
There are many causes for weak bone. The most common is
Osteoporosis, where the bone becomes soft from loss of calcium.
When osteoporosis becomes severe, the vertebrae can break very
easily. Something as simple as a sneeze can cause a fracture. Most
fractures heal with time, but some do not heal well. The fractures
may continue to be a source of pain and make the activities of
daily living like walking or using the bathroom difficult.
Vertebroplasty was developed to help these people. Bone cement is
injected into the vertebrae to strengthen it and also to decrease
the pain. What do
I need to do before the Procedure?
You will need to consult with your doctor to see if you are a
candidate for vertebroplasty. You will also need some tests to
identify which vertebrae are affected and whether the procedure
can be performed safely and with a high degree of success. These
tests include x-rays, an MRI scan, and sometimes a CAT scan. If
you are a candidate for the procedure, you will have some blood
tests done to avoid problems with bleeding. The night before the
procedure, starting at midnight, do not eat or drink anything. Take
your usual medicines on the day of the procedure. Call your doctor
if you take insulin shots. Your doctor may change the insulin dose
for the day of the procedure. Do not take any pain medicine for at
least 4 hours before the procedure. The anesthesiologist will give
you medication to help you relax and feel comfortable during the
procedure. What
happens during the procedure?
The vertebroplasty is performed in a special x-ray room in the
Radiology department (x-ray department) by trained radiologists
and technologists. During the procedure, you will lie face down on
a table that can be moved in all directions. Above the table is a
fluoroscope that uses x-rays so that the radiologist can
"see" what he is doing. The anesthesiologist or
radiologist will give medication that will make you sleepy and
relax you. The technologist will thoroughly clean the skin over
the back. Everyone in the room will be wearing a cap and mask for
your protection. The radiologist will find the broken vertebra and
numb the area with a medication that may sting when injected. Once
the area is numb, the radiologist will place needles into the
broken vertebra using x-rays to guide him. You may feel pressure
on your back. Contrast media (x-ray dye) is then injected into the
vertebra through the needles to make sure they are in good
position. When good needle position is confirmed, cement is then
injected until the vertebra has been filled. The cement does two
things. First, it stabilizes the fracture. Second, the cement gets
hot as it hardens; this heat is thought to destroy the pain
producing nerve endings in the vertebra. The needles are then
removed and the small needle holes are bandaged. What
can I expect after the procedure?
You will be taken to the recovery room and will stay in bed for 4
hours to let the bone cement fully harden. During this time you
can ask for pain medication if needed. Usually, you will go home
the same day and receive a prescription for pain medication.
Remember that this is a surgical procedure and you will likely
have some wound pain that will subside in four to seven days. The
wounds should be kept clean and dry for at least five days. You
will receive written instructions to follow at home. What
are the Risks?
Any invasive procedure may have complications. The radiologist
will discuss possible complications with you before the procedure. One
possible complication is allergy to the medicines or the contrast
media. The contrast media has an iodine base. Tell your nurse or
physician if you have had a reaction to other x-ray dyes, iodine
or any medications. Cement
is injected into the vertebra during the procedure. Sometimes, the
cement can leak outside the vertebra and press on nerve roots or
the spinal cord. In addition, it can migrate to the lung. If these
things happen, cement injection is stopped immediately and usually
there are no problems; however, in a small percentage of cases
these adverse events can lead to worsened pain, paralysis, or
require surgery to remove the cement. Any
procedure that breaks the skin can result in bleeding or
infection. What
about Exposure to x-rays?
Every precaution is taken to protect you from unneeded x-ray
exposure. If there is a chance that you are pregnant, tell your
doctor or the radiologist. The people involved in the test wear
lead aprons because they are exposed to x-rays daily. If
you have any questions about this procedure, please discuss them
with your nurse or physician. Feel free to ask any questions.
This procedure is performed
by SDI Radiologists at St. Joseph's Hospital and Town &
Country Hospital.
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