Vertebroplasty was first performed in France in 1984 to treat compression fractures caused by bone cancer or bone metastasis, and later to treat compression fractures caused by osteoporosis. Percutaneous vertebroplasty was introduced in the United States in 1994 and has become widely available since 1997 as a treatment for pain associated with compression fractures due to osteoporosis. The procedure has been shown to provide continued pain relief for osteoporotic compression fractures Vertebroplasty is likely to become a standard of care for treating osteoporotic compression fractures as more patients and physicians become aware of the new advances in interventional radiology.
Vertebroplasty is an outpatient procedure using X-ray imaging and conscious sedation. The interventional radiologist inserts a needle through a nick in the skin in the back, directing it under fluoroscopy (continuous, moving X-ray imaging) into the fractured vertebra. The physician then injects the medical-grade bone cement into the vertebra. Vertebroplasty takes from one to two hours to perform depending on how many bones are treated. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast.
Some patients experience immediate pain relief after vertebroplasty. Most report that their pain is gone or significantly better within 48 hours. Many people can resume their normal daily activities immediately.
Frequently Asked Questions About Vertebroplasty
Is the procedure safe?
Vertebroplasty is very safe. Although it is a relatively new treatment in the United States, vertebroplasty has been performed for more than a decade at several centers in France with excellent results. The injection technique also has been successfully used for a number of years in the United States to treat other conditions in the spine. For example, it is used to treat cancer and blood vessel abnormalities. The bone cement used to stabilize the fractured vertebrae has been shown to be safe through many years of use in joint replacement surgeries and other orthopedic procedures.
Who is a candidate for vertebroplasty?
People who have suffered recent compression fractures that are causing them moderate to severe back pain are the best candidates for vertebroplasty. In some cases, older fractures may be treated, but the procedure is most successful if it is performed soon after the fracture occurs. The procedure is not used to treat chronic back pain, herniated disks or spinal stenosis.
How successful is vertebroplasty?
Studies have shown that from 75 percent to 90 percent of people treated with vertebroplasty will have complete or significant reduction of their pain.
What are the risks or complications?
Vertebroplasty is a very safe procedure with few risks or complications. In many studies, no complications were reported. 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.
Will vertebroplasty treat or prevent loss of height or "widow’s hump"?
After a vertebra has fractured, there is typically a loss of only 20 percent to 30 percent of the height of the bone. But over several weeks, fractures may reoccur and the vertebra flattens out, until eventually there’s a 70 percent to 90 percent loss of height in the bone. Gradually, the back hunches over and the person loses height, especially if several vertebrae are involved. Vertebroplasty cannot reverse this loss of height or kyphosis (often called “widow’s hump”) in individuals who already have these conditions. Kyphoplasty is a procedure that involves inserting a small balloon at the point where the vertebra has collapsed. The balloon is inflated to raise the bone and then cement is injected into the space. The procedure offers hope to restore or prevent height loss.
On the Horizon
A number of new approaches to vertebroplasty are in development:
- Researchers are looking into new cements that will convert to bone and stimulate bone growth.
- Vertebroplasty may also be used preventively in the future to treat fragile, osteoporotic vertebrae in high-risk patients before the vertebrae fracture.
Reprinted with permission of the Society of Interventional Radiology © 2004, www.SIRweb.org. All rights reserved.