Vertebroplasty People who suffer from painful compression fractures of the spine related to loss of bone mineral (osteoporosis) and other causes (cancer, trauma) may find relief with a new procedure being offered by Radiology Associates. Vertebral Body (Spinal) Compression Fractures: According to the National Osteoporosis Foundation, Osteoporosis, or brittle bone disease, affects 10 million people in the United States. Each year, osteoporosis leads to 700,000 painful spinal vertebral compression fractures (collapse of the weakened bone). Although in most people the fracture heals on its own and the pain goes away and in others pain persists. This is probably because the crushed bone doesn't fully heal and continues to move. Surgery is frequently not an option, because the screws and hardware typically used in spine surgery will not hold in the brittle bone. What is Vertebroplasty? A new technique called percutaneous vertebroplasty (ver-TEE- bro-plasty), offers hope to people who previously have had few options other than spinal bracing and narcotics and other painkillers. Vertebroplasty involves injecting medical cement into the fragile fracture site. It will harden and permanently stabilize the fracture, thereby improving or relieving back pain. Most patients treated will have complete or significant reduction of their pain with vertebroplasty. The procedure is generally safe, with few risks. The potential complications and risks of the procedure should be discussed with your doctor. Prior to the procedure, radiologist use X-rays, magnetic resonance imaging (MRI) and bone scans to find the fracture or fractures that are causing the pain, and to rule out other causes of pain that may not be treatable with this technique. When the area is located and confirmed, an intraventional radiologist injects bone cement into the vertebra under X-ray guidance using a hollow needle. The procedure takes one hour and it typically is performed with local anesthesia and intravenous sedation. Occasionally, general anesthesia may be necessary. The bone cement hardens within 15 minutes and the patient remains at bed rest for 3 hours. The procedure can be performed on an outpatient basis. The Procedure: Upon arrival into the procedure suite, you will be placed on your stomach on the procedure table. The nurse will be giving medication through an intravenous line to sedate and relax you. Occasionally, general anesthesia may be required. You will be connected to monitoring equipment to continuously monitor your heart rhythm, blood pressure and oxygenation. You will hear the technologists, nurses, and doctors setting up the equipment and supplies for the procedures. They will talk to you at various points to let you know what is happening. It is important that you try your best to be still. This will improve the results of the x-ray images and minimize the length of your procedure. The skin on your back overlying the fractured vertebra will be washed with sterile soap and draped with sterile sheets and towels. This area will be anesthetized with numbing medication. A special needle is then advanced into the affected vertebra under fluoroscopic (x-ray) guidance. This insures correct needle placement prior to injecting the cement. A medical cement is then mixed with a contrast agent to make it more visible with fluoroscopy. This allows doctors to see the mixture on the x-ray screens as it is injected to fracture of bone. When enough of the cement has been injected, the needle will be removed and gentle pressure will be applied over the puncture site. No stitches are required. A sterile dressing will be applied. After the Procedure As soon as the procedure has been completed, you will be transferred onto a stretcher and will remain on your back for 3 hours. This allows complete curing of the cement prior to standing. You will be on clear liquids and quickly advance to your normal diet as tolerated. The nurse will assist you for your first time up, as you may be tired from the medications and/or light-headed from being flat for so long. Many of our patients go home the same day, some as soon as four hours after the procedure is completed. Arrangement for a family member or a friend to drive you home should be made prior to your discharge. Your activities at home can be increased as tolerated. Please do not attempt any strenuous activity at first. Be gradual and use your common sense to guide you. You may feel so good that you forget you did have a major procedure done. No heavy lifting is advised for up to one week; e.g., nothing heavier than a pocket book or a small bag of groceries. Follow-Up Depending on the specifics of your condition, you may be referred to a physical therapist or other rehabilitation services as needed. Also, you may receive an exercise instruction sheet if your doctor has prescribed such activities. Your back pain may be relieved immediately or within a few days. If not, you may need to be re-evaluated by your referring physician for new fractures or other possible causes of pain. There is a possibility that similar pain can occur in different location. This indicates that you may have developed another fracture. If so, you should contact us for further evaluation and treatment. The cement makes the vertebral body stronger, possibly even stronger than normal bone, and can prevent further collapse. The procedure generally does not, however, return the vertebrae to its former size. The outcome of the procedure in patients has been very encouraging, with the majority of patients experiencing partial or complete pain relief. This minimally invasive treatment can give people back their mobility, and increase the quality of life. We have been performing vertebroplasty at Radiology Associates since June of 1999. Most of the patients treated have had significant or even complete relief of their pain. Frequently Asked Questions: Is it safe? Yes. Thousands of patients have undergone this procedure. Vertebroplasty has been performed for many years in Europe. The chance of complication is low. As with any medical procedure, the possibility of complications will depend on the individual patient. For example, patients with tumors in the spine or with other serious medical conditions may be at higher risk for complications from vertebroplasty. You should always ask your doctor to discuss risks and complications with you before you undergo any procedure. Is it covered by insurance? It is often an outpatient procedure, with about a 4 hour recovery period. The patient can often be sent home the same day. Some patient's will stay over night. Depending on how far they have to travel. Do I have to be put to sleep? No, the procedure is done using local anesthetic and some light sedation given intravenously during the procedure. How long does it take before a result can be expected? Most patients experience pain relief within the first 48 hours. This gradually improves over the next few weeks. How effective is vertebroplasty? With good patient selection and good technique about 75-90% of the patients will experience significant pain relief within the first few days after the procedure.