Vertebroplasty: Non-Surgical Treatment of Compression Fractures - Part 1 of 2

Jonathan Wiener, MD

Director, MRI and Neuroradiology

Boca Raton Community Hospital

Boca Raton, FL

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Background

Osteoporosis affects more than 30 million Americans. Compression fractures occur in more than 500,000 patients per year in the US, are more frequent than hip fractures, and often result in prolonged disability. Risk factors include advanced age, Caucasian or Asian race, low weight, diseases such as kidney failure, and medication use such as prednisone. Current preventative measures include calcium and vitamin D supplementation, exercise, smoking cessation, and medications such as biphosphonates.

Management includes pain control with acetaminophen (Tylenol), non-steroidals (Motrin), narcotics (Percocet), and bracing. Unfortunately, the compression fractures often progress and develop at other levels resulting in loss of height, disability, and secondary complications from immobilization including pneumonia and pulmonary embolism.

Percutaneous vertebroplasty has recently been introduced into the US as an effective therapeutic and preventative treatment for the pain and progressive loss of height in compression fractures.

What is Vertebroplasty?

Vertebroplasty literally means fixing the vertebral body. A metal needle is passed into the vertebral body and a cement mixture containing polymethylmethacrylate (PMMA), barium powder, tobramycin, and a solvent are injected under imaging guidance by the physician. The cement hardens rapidly and buttresses the weakened bone. The barium makes the cement visible on x-ray and the tobramycin is an antibiotic. The procedure was originally developed in France in 1984 and has been further refined in the US since 1995.

vertebroplasty anatomical axial ct mri labeled weiner

How is it performed?

Usually, the procedure is performed in an interventional radiology suite with special x-ray equipment (c-arm fluoroscopy) with nurses and technologists to help sedate the patient and operate the equipment. The patient is placed prone on the x-ray table and made as comfortable as possible. Sedation usually includes a narcotic (fentanyl) and a benzodiazopine (versed), which are short acting and can be reversed if necessary.

vertebroplasty needle progression fluoroscopy weiner

The skin and underlying tissues are anesthetized with lidocaine and a special bone needle is passed slowly through the pedicle into the vertebral body using a slightly angled posterior approach.

(See images above)

Posted on: June 12th, 2000
Last Updated on: February 1st, 2010

Peer Reviews by Leading Specialists

What is this?

Thomas G. Lowe, MD

After reviewing the article on vertebroplasty by Dr. Jonathan Wiener, I have several comments to make. Certainly the results of vertebroplasty for relief of pain are very good. The author neglected to mention a newer technique for the treatment of compression fractures in the elderly, namely kyphoplasty. Kyphoplasty has eliminated many of the complications that surfaced from the use of vertebroplasty.

The technique of performing vertebroplasty is nicely described in the manuscript. Because the methylmethacrylate is injected directly into the vertebral body, there is a significant risk of inadvertent injection into the spinal canal resulting in spinal cord injury. With the kyphoplasty technique, two balloons are inserted through the pedicles and inflated reducing the fracture and creating a cavity in the vertebral body for junction of methylmethacrylate after removal of the balloons. The walls of the cavity are compressed cancellous bone, which reduce the likelihood of methylmethacrylate being inadvertently injected into the spinal canal.

In conclusion, both vertebroplasty and kyphoplasty are 70% - 90% successful in relieving pain. However kyphoplasty is a better solution because it results in correction of the deformity and minimizes the risk of neurological injury from methylmethacrylate being inadvertently injected into the spinal canal.