- How is Percutaneous Vertebroplasty Performed?
- Side Effects and Alternatives to Percutaneous vertebroplasty
Percutaneous vertebroplasty (PV) is a new treatment that involves injecting a special liquid cement into fractured vertebral sections. PV is being used to fill holes in the spinal column left from osteoporosis, a degenerative bone disease. Spinal compression fractures are a common problem for women with osteoporosis and may cause deformation, pain, and the potential loss of sensation, mobility, and continence. PV helps rebuild the collapsed spine and relieves pain and pressure. In a recent study, 29 of 30 patients experienced significant pain relief immediately after the procedure and 80% of the patients reported lasting pain relief.
In the United States, there are approximately 700,000 spinal compression fractures each year from osteoporosis and 80% of those fractures occur in women.
Percutaneous vertebroplasty (PV) is usually reserved for patients who have not responded well to prior conventional treatment of osteoporosis with pain relievers or bed rest. Before PV, patients are given a mild sedative. To perform the minimally invasive operation, a surgeon places a needle through the skin into the area of the spine needing treatment. X-rays (fluoroscopy) are used to help guide the needle. Once the needle is positioned properly, a special liquid cement (called polymethylmethacrylate) is injected into the spinal fracture. The liquid cement is a special medical compound commonly used to cement artificial joints in place. It is mixed with an antibiotic powder to prevent infection and a barium powder so that it can be seen under the x-ray machine during injection.
Once injected, the liquid cement takes approximately 20 minutes to harden. When it hardens, it becomes a permanent spinal reinforcement. In many cases, a second needle puncture is needed to fill the other side of the vertebra. According to Gregg Zoarski, MD, who recently conducted a study on PV, the liquid cement does not affect the mobility of the spine, and patients are able to move freely once it is in place.
The procedure usually takes about one hour per vertebra. After the liquid cement has been injected into the spine, patients will typically be instructed to rest on their back for an hour before getting up. The majority of patients can leave the hospital or outpatient facility within two hours after the procedure. It may take several weeks before patients can resume full activity. In some cases, physicians will recommend a short course of physical therapy.
According to Dr. Zoarski, percutaneous vertebroplasty (PV) may also help prevent severe deformity from repeated spinal fractures. If a patient undergoes the procedure soon after each fracture, deformity could be minimized. To determine which patients might be candidates for PV, physicians perform magnetic resonance imaging (MRI) exams to be certain a patient's back pain is not due to other back problems such as herniated discs or spinal cord tumors.
Percutaneous Vertebroplasty (PV) is being performed at select hospitals, medical centers, and physicians' offices across the U.S. It is estimated that approximately 300 interventional radiologists are trained to perform PV in the U.S. The Montefiore Medical Center in New York performs approximately 30 neurointerventions per month, including many vertebroplasty surgeries to treat spinal fractures. Jacqueline A. Bello, MD, director of neuroradiology at the Montefiore Medical Center believes minimally invasive neurointerventions are going to become more commonplace in the future. In the U.S., there are approximately 700,000 spinal compression fractures each year from osteoporosis and 80% of those fractures occur in women.
The side effects of percutaneous vertebroplasty (PV) are rare and occur in less than one percent of patients who undergo the procedure. Possible side effects include:
- Another fracture
- Pain or weakness
Editor's note: In October 2002, the U.S. Food and Drug Administration (FDA) issued a warning about possible complications of the cement used in vertebroplasty and kyphoplasty procedures. The complications include soft tissue damage and nerve root pain and compression, are related specifically to the leakage of bone cement. Other reported complications include pulmonary embolism, respiratory and cardiac failure, and death. Click here to read more about the FDA statement.
More common treatments for osteoporosis include hormone replacement therapy or treatment with a variety of drugs such as raloxifene (brand name, Evista), alendronate (brand name, Fosamax), or calcitonin (brand name, Miacalcin).
Osteoporosis is a degenerative bone disease that primarily affects post-menopausal women. A loss of bone density causes bones to become brittle, and in turn, leads to frequent fractures and other serious effects. According to researchers, when a spine fracture occurs from osteoporosis, 20% to 30% of the damaged vertebral section is typically lost. Within weeks, more fractures may occur which can lead to a loss of height. Older women who are affected by osteoporosis-induced spinal fractures generally lose weight and develop a hunched back.
- The March 28, 2000 Health Network report by John Martin, "Weakened Spine Treatment: Liquid Cement"
- The Boca Radiology Group in Boca Raton, Florida provides information and case studies on vertebroplasty.
- Learn more about osteoporosis.