Vertebroplasty

Vertebroplasty

What is Percutaneous Vertebroplasty?

Percutaneous vertebroplasty (PV) is a new procedure used to treat painful compression fractures of the spinal bones (vertebrae).  This technique involves putting a needle into the fractured bone using X-ray to guide the placement.  It is followed by the injection of a medical grade cement called PMMA.  PMMA stabilizes the fracture and reduces or relieves pain.  Because vertebroplasty requires only a small skin opening, it is performed on an outpatient basis by radiologists who specialize in these kinds of procedures.

What causes compression fractures in the spine?

Our skeleton is the framework that holds up our bodies.  It is made up of living bone cells which are usually hard and strong.  Bone continually undergoes a process called remodeling, whereby old bone cells are broken down and replaced by new bone cells.  As we get older, the breakdown of old bone begins to happen faster than the formation of new cells.  More bone cells end up being lost than replaced.  As a result, bone thickness decreases, causing a condition called osteoporosis.  In the spine, osteoporosis affects individual bones and "compression fractures" occur when the bones can no longer support a person's weight.

Osteoporosis is more common in women who have been through menopause since bone loss is increased by lack of female hormone production.  However, not all bone loss is age or gender related.  Some individuals, like those on long-term steroids for organ transplants, breathing problems or other endocrine disorders, may develop a painful vertebrae fracture.  Benign tumors and cancers involving the vertebrae can also lead to bone loss and compression fractures.

Who may be a candidate for vertebroplasty?

Compression fractures are often very painful but the majority of them heal over time.  Most people with fractures from osteoporosis do well with bed rest, pain medication and occasionally, back bracing.  In other patients with osteoporosis or the other causes listed above, the pain from a compression fracture is so severe that this type of treatment is of little help.  The pain never fully goes away.  Vertebroplasty has been used to successfully treat these patients.

Who is not a candidate for vertebroplasty?

Patients with fractures from severe trauma (automobile accident, falls, etc) are not candidates for vertebroplasty.  Patients with other types of back problems such as herniated, or "slipped" disc, arthritis of the back, muscle spasms or narrowing of the spinal canal (spinal stenosis) will not be helped by vertebroplasty.

Who performs vertebroplasty?

Vertebroplasty was developed in France but was first performed in the United States at UVA by Dr. May Jensen and a colleague.  Dr. Jensen performs vertebroplasty procedures in the Neuroradiology suite at the University of Virginia.  Through her efforts, the University of Virginia is the recognized leader of vertebroplasty in the U.S. today.

How successful is vertebroplasty in relieving pain?

No procedure is 100% successful, but 80% of patients have significantly reduced pain after Vertebroplasty.  Among the remaining, half report receiving some relief, while the other half report no change.  No patient has reported a worsening of his or her pain.

The procedure and follow-up care

Once you arrive for your procedure, you will be taken to the Neuroradiology recovery room to be prepared for your procedure.  There, the nurse will assist you in getting into a hospital gown.  You will have a brief physical exam done by the nurse.  As part of that exam, the nurse will check your blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation.  He/she will insert an IV catheter so that medication can be given to you during the procedure.  The medication will help you relax and be more comfortable.  In rare cases, general anesthesia may need to be used.  However, this would be discussed with you and planned in advance.  Once the physicians have explained the procedure to you and you have had all your questions answered, the procedure can begin.

The procedure is performed in the Interventional Neuroradiology Suite, and usually takes 1-2 hours.  You will be helped to lie on your stomach during the procedure.  The treatment area will be cleaned and numbed by a local anesthetic.  A small opening will be made in the skin and a needle will be inserted.  The process of guiding the needle to the proper place is done by watching real time x-rays.  Once the needle is where it should be, a small amount of dye may be injected.  This is done so that there is a clear picture of the location of the veins.  The medical cement (PMMA) is then injected into the vertebrae.  Real time x-rays continue to be used to monitor the drop by drop injection of the PMMA into the vertebrae.  When this medical cement has hardened, "internal casting" will virtually prevent any further collapse of the vertebrae.  Im most cases, it will provide significant relief from pain within 24-48 hours.  A Band-Aid is placed over the needle site.

After the procedure you will be helped to roll onto your back.  You will rest in the Neuroradiology recovery room on your back for one-two hours.  A post-procedure evaluation, consisting of vital signs and a physician assessment of your condition, will be done.  After this you will first be assisted to sit and then to stand.  In most cases, you will be discharged within several hours.

You will be contacted by telephone one day and one week after your procedure to see how you are doing.  If needed, an appointment for an evaluation may be scheduled.  We recommend that regular x-rays 6 months after your procedure be sent to us so that we may follow your response to the procedure.

What are the risks?

All procedures involve some risk.  The risk of having vertebroplasty is generally less than 1%.  The risks include:

  • Bleeding
  • Infection
  • Allergic reaction
  • Fracture
  • Cement migration (the cement goes outside of the vertebral body where it is placed)
  • Canal narrowing (where the space in the vertebrae that the spinal cord goes through becomes smaller)
  • Pulmonary embolus (where the medical cement goes from the vertebral veins to the lungs causing blockage of the blood supply to the lungs)
  • You also may not obtain relief of your pain and this could cause you continued discomfort.

How do I get evaluated for vertebroplasty?

Your Primary Care Provider (PCP) can refer you for Vertebroplasty evaluation.

If you would like to be evaluated for this procedure, please have your PCP or doctor managing your care contact our office at:

University of Virginia Health System
Department of Radiology
c/o Dr. Jensen
Main Hospital, Lee Street
Charlottesville, VA 22908
Phone:  (434) 924-9719
Fax: (434) 982-1618

At that time, we will ask your physician to provide with:

1.  A brief letter of introduction, asking for our opinion on your condition.
2.  Pertinent clinical/office notes which describe:

  • when your pain started
  • treatments that we attempted and how you responded to them
  • your medical and surgical history
  • any other information which will help in your evaluation process

3.  Any x-rays you have had performed which show your fracture(s).  These may be regular x-rays, CT scans, MRI scans, or nuclear medicine bone scans.

One we receive the information, our doctor will review your x-rays and clinical notes.   If you are not a candidate for the procedure, we will contact your PCP to explain why you are not eligible.  We are also happy to contact you directly if you or your PCP would like us to.

If Dr. Jensen thinks this procedure could help you, you will be contacted to make an appointment for an evaluation and consultation.  During your consultation, we will discuss with you the risks and benefits of Vertebroplasty.  We will obtain a detailed history of your condition, perform a special kind of x-ray, which helps to determine the location of your pain in relation to the site of your fracture.  If needed, we may also schedule additional x-rays of the affected ares.

Once the clinical evaluation and any additional x-rays have been completed, it will be determined if you are a candidate for the procedure.  If you are eligible, you may then schedule an appointment to have the procedure done at the next available opening.  Often, we are able to perform your Vertebroplasty the very next day or possibly later the same week.

 

For any questions or concerns:

Contact the Radiology and Medical Imaging department at 434-924-9400.