Vertebral Augmentation procedures

Vertebral augmentation is a procedure in which vertebral compression fractures are treated from the ‘inside-out’ with special medical cement. This is done by inserting needles into the fractured vertebral body using x-ray guidance. Once the needles are positioned, either balloons are inserted to create a cavity (kyphoplasty) followed by installation of toothpaste-like consistency cement, or cement alone is inserted into the vertebral body (vertebroplasty). When the cement hardens, the vertebral fracture is stabilized and pain is improved.

The procedure is done in utilizing high resolution x-ray fluoroscopy in an operating room-like setting in an interventional radiology suite. The procedure is usually done with intravenous sedation and local anesthesia, which provides excellent pain relief during the procedure. The procedure takes about 30 minutes to an hour or so and is generally done as an outpatient procedure. After the procedure the patient is observed and subsequently discharged several hours after the procedure.

Risks

The risks are low and the benefits in terms of pain relief and fracture stabilization are high. A consultation with the performing radiologist including a review of your history, pertinent laboratory values, x-ray findings, physical exam is available.

Vertebral compression fractures (VCF) are usually related to osteoporosis. Osteoporosis is a disease in which there is decreased bone mass and a deterioration of bony architecture. It is a disease in which the rate of bone loss exceeds the rate of new bone formation. Osteoporosis is a disease affects women more than men and is known as a stealth disease, which is asymptomatic until a fracture occurs. As a result of decreased bone mass, the patient is at increased risk for fractures. It is estimated that 25% of all post menopausal women suffer from VCF and the prevalence steadily increases with advancing age. 1 (Amer Fam Physician, Jan 1 2004).

Vertebral compression fracture

Symptoms

The symptoms of vertebral compression fractures include pain with accompanying disability and diminished quality of life including mobility, performing activities of daily living, limitations on lifestyle and independence. Patients with one VCF may be at risk for additional fractures of all types with corresponding morbidity and mortality. The consequences of VCF also may include decreased lung function and possible pneumonia, poor balance, muscle loss, changes in diet and satiety, possible formation of blood clots due to immobility, change in bowel habits, emotional and social issues, among others.

Vertebral compression fractures are often experienced with only minor trauma including bending, lifting, climbing stairs or coughing. (2. Cooper, C et al. J Bone Min Res. 1992;7:221-227.) The patient experience pain over the fracture site and is usually worse with standing. Sometimes they are attributed to aging or arthritis.

The most common location for vertebral compression fractures are in the mid thoracic region and the thoracolumbar junction.

The fractures may be diagnosed with plain x-rays, MRI , bone scan or CAT scan techniques. Treatment options are either conservative therapy including bed rest, back bracing or narcotic analgesics or vertebral augmentation. The conservative treatment may work but sometimes pain is not relieved or the fracture progresses. The other option is vertebral augmentation, which include vertebroplasty or kyphoplasty. After a consultation, your radiologist will determine which procedure is best for you.

Studies have shown vertebral augmentation offers fast pain relief, quicker return to mobility, better quality of life, high patient satisfaction and very low complications.