Health Facts: Percutaneous Vertebroplasty

HEALTH FACTS

PERCUTANEOUS VERTEBROPLASTY

What is Percutaneous Vertebroplasty

Percutaneous Vertebroplasty is a new technique for treating osteoporotic spinal fractures. Each year in the United States, 700,000 new osteoporotic vertebral compression fractures occur. This results in 115,000 admissions to the hospital for pain control. Individuals with one vertebral compression fracture have a five-fold risk of subsequent vertebral fractures. The pain that occurs after an acute collapse of the vertebral body can be quite severe causing patients to become temporarily bedridden or wheelchair bound. This pain may last for 4-10 weeks after an acute collapse of the vertebral body. Osteoporotic collapse of the vertebral bodies typically occurs in the upper (thoracic) and lower back (lumbar).

This pain is often managed conservatively by prescribing bedrest, pain relievers, and a back brace. In the mid 1980, the French radiologist, Herve Deramond, performed the firstPercutaneous Vertebroplasty. This is a minimally invasive technique in which a needle is placed through the skin (ie percutaneously) into the recently collapsed vertebral body under fluoroscopic guidance. and glue similar to that used in “cementing” in a total hip replacement is injected into the collapsed vertebral body to stabilize it and prevent further collapse. This “internal casting” of the acutely collapsed vertebral body provides increased pain relief and increased mobility to patients in 80% of the cases.

Indication and Patient Selection

Percutaneous Vertebroplasty is indicated in the patient with persistently painful collapsed vertebral body who has failed standard conservative medical measures for pain control. The pain arising from the painful collapsed vertebral body is focal, intense, deep and in the midline. Manual pressure on the midline of the back at the location of the collapsed vertebral body reproduces the patient’s pain. The patients that respond the best to vertebroplasty have had their collapsed vertebral body for six months or less. The primary goal of vertebroplasty is to alleviate pain and stabilize the vertebral body.

Percutaneous Vertebroplasty is indicated in patients with painful osteoporotic vertebral compresson fractures refractory to conservative medical therapy. Potential patients will be seen and examined by a team of physicians. This team consists of physicians with special expertise in osteoporosis from the Department of Endocrinology, physicians from the Departments of Orthopedic and Neurosurgery and physicians from the Department of Diagnostic Radiology. The potential patients will have X-rays taken of their back and will undergo a CT scan and MR scan of their backs. Each patient will then be discussed among the team of physicians and a decision will be made regarding the potential effectiveness of Percutaneous Vertebroplasty in the individual.

Preparation

In most instances, the Percutaneous Vertebroplasty procedure generally will be performed in the early afternoon The patient should not eat for 8 hours prior to the procedure. The patient may take their medications with a sip of water. If the patient takes insulin for Diabetes Mellitus,

one-half (½) the usual morning dose should be taken in the morning the day of the procedure.

It is important that a friend or family member drive you to the hospital and home from the hospital. The patient is asked to stop taking aspirin starting four days before the procedure and to alert the physician if he/she is taking coumadin for blood clots, heart rhythm disorders or an artificial heart valve. In these situations, a more indepth planning will need to be done prior to the performance of Percutaneous Vertebroplasty.

Procedure

On the day of the procedure, the patient will meet a physician from the Department of Diagnostic Radiology and/or Orthopedic Surgery. The procedure, its risks, and benefits will be discussed at length with the patient. Also, a member from the Department of Anesthesia will discuss the risks of either monitored anesthesia care or general anesthesia. Once both of these discussions are completed, the patient will change into a hospital gown, and go into the angio suite. The angio table will have additional padding on it to create a comfortable support as the patient rests in the prone position. The Anesthesia Staff will then either place the patient under general anesthesia or monitored anesthesia. During this time, the patient’s blood pressure, oxygenation and vital signs will be constantly monitored. With the patient resting comfortably, she/he will be transferred from the supine to prone position. The site of vertebral collapse will be localized with fluoroscopy and the overlying skin of the back will be cleansed with iodine-based soap called Duraprep (it is important that if you are allergic to soaps that you communicate this to the physician). After cleansing the back, a sterile surgical drape will be applied to the back. With fluoroscopic guidance one and some times two needles are passed through the skin and into the collapsed vertebral body. This is done under constant fluoroscopic guidance.Once the needles are securely in the collapsed vertebral body, the physician will inject the “cement”. The cement stabilizes the affected vertebral body and relieves the associated pain. After the injection of the cement, the needle/s will be removed. At times, two or three adjacent symptomatic and collapsed vertebral bodies will be treated at the same setting

After the Procedure

Once the procedure is completed, the patient will regain full alertness either in the Anesthesia Recovery Room or in a bed in the Inpatient Service of the UWHC. Again the patient’s vital signs (ie blood pressure, temperature and pulse oximetry) will be constantly monitored. Typically, the patient will be observed for the ensuing four or 23 hours in the hospital after which time, she/he will be allowed to go to home. The patient will be given the card of the physician who performed the procedure. That physician will call the patient up for follow-up within 24 hours of procedure completion. The patient and accompanying family member or friend will be told to call this physician if any of the following occur:

1. Sudden onset of pain radiating down the leg
2. Sudden onset of weakness of the arm or leg
3. Sudden onset or worsening shortness of breath
4. Pain at the skin site in which the needle was inserted
5. New onset of rib pain.

Otherwise, the patient should see her/his physician within one week’s time for follow-up.

2001Written by: John C. Mc Dermott, MD; Michael Tuite, MD; Neil Binkley, MD; Beverly Aagaard, MD;

Kirk Davis, MD; Robert Blank, MD; Marc Drezner, MD; Barbara Sargent, RN, CNM; and Judy

Harke, RN, NP.