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 10/23/2014

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University of Texas Southwestern Medical Center @ Dallas

The University of Texas Southwestern Medical Center @ Dallas University of Texas Southwestern Medical Center
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Vertebroplasty

What Is Vertebroplasty?
Vertebroplasty provides new hope for those suffering from severe back pain caused by osteoporosis, metastatic tumors or dialysis. These conditions can cause bones to become brittle, resulting in weakened vertebra. Once this happens, the smallest activity can cause these vertebrae to collapse. The pain from these vertebral compression fractures is extreme, which limits the possibility of normal movement or simple activities.

In the past, people who had these types of fractures had three options: pain medications, bed rest and external bracing. While these conservative options are still the first choice for reducing discomfort, if severe pain persists, patients can now be referred to a specially trained physician to see if Vertebroplasty will work for them.

Immediate Pain Relief-Minimally Invasive
Vertebroplasty works by stabilizing the collapsed vertebra using specially formulated acrylic bone cement. It's done as an outpatient procedure-no hospitalization, no surgery-and requires only a local anesthetic. Once the area of the spine is numb, the doctor inserts one or two needles through a small incision.

Most patients experience pain relief within hours. Best of all, patients are able to resume their daily activities within 48 hours.


How it works

Diagnosis
In a compression fracture of the vertebrae, the bone tissue of the vertebral body collapses. More than one vertebra may be affected. This condition is commonly caused by osteoporosis and less often by tumor, or trauma to the back.

When the fracture occurs as a result of osteoporosis, the vertebrae in the thoracic (chest) and lower spine are usually affected, and symptoms may become worse with walking.

With multiple fractures, kyphosis, a forward hump-like curvature of the spine, may result. Pressure on the spinal cord may occur producing symptoms of numbness, tingling, or weakness.

Symptoms depend upon the area of the back that is affected. In some cases, the fracture heals without treatment and the pain goes away. In others, the bone does not stabilize and continues to move, causing persistent pain that in turn limits physical activities and reduces independence.

How the procedure works
Vertebroplasty requires that you lie on your stomach through the entire procedure, which is performed under local anesthesia and light sedation. A small nick is then made in the skin near the spine, and a needle is inserted. Biocompatible bone cement will be injected through the needle and into the vertebral body. The needle is removed and the cement is allowed to harden. The small opening is covered with a bandage.

Step 1: Initial Entry: A biopsy needle is guided into the fractured vertebra through a small incision in the skin.

Step 2a: Stabilization: Acrylic bone cement is injected into the vertebra

Step 2b: Acrylic bone cement fills the spaces within the bone.




Post operative
This procedure can take from 1-2 hours (depending on how many vertebrae are treated). You will be required to remain for observation for one to two hours. Typically, patients are then released to go home and resume normal activities within 24-48 hours. In most cases, pain caused by vertebral compression fractures will be gone or diminished within 48 hours. You might experience some discomfort or bruising where the needle was inserted.




Indications and Contraindications

Indications

» Painful Fractures
· Osteoporotic fracture refractory to medical therapy
· Benign or malignant tumor: hemangioma, multiple myeloma, metastatic lesion
· Osteonecrosis

» Unstable Fractures
· Unstable fractures with movement at wedge deformity
· Multiple thoracic compression deformities with decreased thoracic cage threatens pulmonary compromise, impacts appetite, GI function, balance
· Possible structural reinforcement prior to surgical stabilization

» Patient Selection
· Focused pain in region of fracture
· Fracture tender to palpation
· Absence of radicular pain
· Subacute or acute fractures less than one year old yield greatest results (less than 4-6 months ideal); older fractures can also be treated
· Fracture unresponsive to medical therapy (analgesics, bedrest, immobilization)
· Fracture with activity on bone scan or edema on MRI, if in combination with other selection criteria
· Pain from fracture negatively impacting mobility and ADLs




Contraindications

» Absolute Contraindications
· Asymptomatic stable fracture
· Clinically effective medical therapy
· Osteomyelitis of target vertebra
· Uncorrected coagulation disorders
· Acute traumatic fracture of non-osteoporotic vertebra
· Prophylaxis with no evidence of acute fracture
· Allergy to any required component
· Local or systemic infection

» Relative Contraindications
· Radicular pain or radiculopathy caused by a compressive syndrome unrelated to vertebral body collapse
· Retropulsed fragment with > 20% spinal canal compromise
· Tumor extension into epidural space
· Severe vertebral body collapse (vertebra plana)
· Stable fracture without pain older than one year









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