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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?
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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. |
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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) |
See
Part II of Article
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Editorial
Board Comment
“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.”
Thomas
G. Lowe, MD
- Editorial
Board, SpineUniverse
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