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Who is a candidate for vertebroplasty or kyphoplasty?

By Kevin RR Williams

HEALTH Prior to vertebroplasty and the similar procedure kyphoplasty, a more common remedy to vertebral compression fractures (VCF) was fusion — typically with bone grafts or metal screws, wires and rods or plates. Metal may still have its place, but can sometimes be avoided with vertebroplasty. “What is vertebroplasty?” “Does the related procedure kyphoplasty cure back pain?” and “Is either right for me?” you may wonder.

VCF is when the vertebra collapses into itself to form a wedge shape (narrower in the front). This may be caused by osteoporosis, metastatic tumor, multiple myeloma, vertebral hemangioma, lifting a heavy object, or even coughing and sneezing. A 15% loss of vertebral body height constitutes a vertebral compression fracture.

How is it performed?

First introduced in 1987 by Galibert et al., over the past three decades, vertebroplasty and kyphoplasty have emerged as minimally invasive surgical options that play a central role in the treatment of VCF. Vertebroplasty involves the percutaneous injection through a needle or trocar into the fractured vertebra to fill the compressed vertebra with bone cement (polymethylmethacrylate). For kyphoplasty, a balloon is first inserted and inflated to expand the same vertebra to its normal height before filling the space with cement. The cement-strengthened vertebra allows the patient to stand straight, reduces pain, and prevents further fractures. With the medical procedure performed early in the day, a patent may be able to return home by the evening. Proper patient selection and good technique should minimize complications.

The PMMA bone cement is not comprised of silicone or latex, which triggers allergic reactions in some people. Rather, the bone cement is a self-curing material that might be known to you as acrylic, Acylite, Plexiglas, Lucite or Perspex. The bone cement viscosity changes over time from a runny liquid into a dough-like state that can be safely applied and then finally hardens. Alternatives to PMMA with similar biomechanical properties for strength and stiffness include calcium sulfate cement and calcium phosphate cement.

Can Vertebroplasty Correct Dowager’s Hump?

Dowager’s hump, also called humpback is often caused by weakened bone (osteoporosis). This exacerbates VCF. Restoring vertebral shape relieves stress on neighboring vertebrae and reduces the abnormal curvature of the spine.

What Are The Risks?

Vertebroplasty is generally well tolerated, with complications usually minor and occurring at a rate of 1 percent to 3 percent. But patients can face risks such as:

  • Hemorrhaging
  • Blood loss
  • Fractures of ribs or other nearby bones
  • Fever
  • Nerve root irritation
  • Infection
  • Cement flowing outside of the bone before it hardens

Vertebroplasty is not for everyone. For example, it does not cure vertebral misalignment, herniation, osteoporosis (leading cause of VCF), or cancers that might trigger vertebral compression fractures. A single vertebral fracture significantly increases risk of further fractures. Unresolved infection and the length of time since bone deformation may determine if it is advisable to deflate vertebrae. In the rare event bone cement needs to be later removed, the affected vertebrae will become even weaker than prior to initial operation. Speak to a qualified orthopedic specialist and review all available options to get A Bit More Healthy. Look for our poster on Low Back Pain in the online store.

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Tags: lower back, orthopaedic pain management, skeleton, spine

References
  1. Vertebroplasty & Kyphoplasty. mayfieldclinic.com
  2. Bone Cements: Review of Their Physiochemical and Biochemical Properties in Percutaneous Vertebroplasty. ajnr.org
  3. Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events. nih.gov
  4. Vertebroplasty. hopkinsmedicine.org
  5. Poly(methyl methacrylate). wikipedia.org
  6. New spine surgery at BMC straightens dowager’s hump. Boston University, 2003
  7. Vertebroplasty After a Painful Spine Fracture (video). spine-health.com
  8. Medical Devices of the Neck and Spine. medapparatus.com
  9. File:VertcementX.png. wikimedia.org