Vertebroplasty

In Vertebroplasty Inject bone cement directly into the fractured vertebra. After injected, the cement hardens in about 10 minutes, congeals the fragments of the fractured vertebra, and provides immediate stability.

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With aging, continuous wear and tear, deficiency of calcium and vitamin our spine or the back bone is affected by a condition called Osteoporosis. This condition makes the spine weak and vulnerable to fractures over a period of time. Most of the spine fractures in old age are caused by osteoporosis and many of such patients suffering from this condition might need a surgical intervention. A surgical intervention may be required when a severe pain still persists in spite of non-operative measures like bed rest, hospitalization, pain killer medications or bracing. Vertebral Fracture Severe Osteoporosis is might lead to vertebral fractures, that are caused spontaneously or due to minor trauma. These vertebral fractures are often highly painful and are treated with immobilization, analgesic drugs, and specific treatment of osteoporosis. In many cases conservative treatments may not give much relief as the condition worsens over a period of time leading to severe pain in spite of long-term medical treatment. Vertebral fracture might lead to other conditions like reduced height, kyphosis (hunch back), and chronic back pain. Percutaneous Vertebroplasty is indicated for painful osteoporotic or neoplastic vertebral compression fractures when all conservative treatments fail. Vertebroplasty Vertebroplasty is also known as Percutaneous Vertebroplasty. This procedure is carried out in order to strengthen the spine and relieve the pain. In this procedure, bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra. Vertebroplasty is used for patients with vertebral compression fractures due to osteoporosis, metastatic tumors, or benign tumors such as vertebral heamangiomas. It also provides vertebral stabilization when the lesion threatens the stability of the spine. Vertebroplasty can increase patient mobility, decrease narcotic needs, and prevent further vertebral collapse. Procedure Vertebroplasty is a minimally invasive procedure. Here the spine surgeon uses a image-guided technique. This procedure is performed under local anaesthesia and light sedation. During the procedure, bone cement, polymethylmethacrylate(PMMA) is injected with a biopsy needle into the collapsed or fractured vertebra with x-ray guidance. The acrylic cement quickly dries and forms a support structure within the vertebra that provides stabilization and strength. The needle makes a small puncture in the patient's skin that is easily covered with a small bandage after the procedure. Recovery Since Vertebroplasty is a minimally invasive surgery, the recovery of the patient is quicker. This procedure involves very little blood loss and less damage to the surrounding tissues. This procedure is generally done on out-patient basis where the patients are kept under observation for 1-2 hrs after which they are discharged. After a successful vertebroplasty procedure, the patient can return to routine activities within a week.

dvanced age, asthma, diabetes, emphysema, menopause, chronic steroid use and rheumatoid arthritis are all risk factors for osteoporosis. The resultant weakening of bones can lead to compression fractures of the spine causing severe pain, deformity, loss of height, immobilization, and in some cases, failure to thrive.

It is non surgical treatment for osteoporotic and metastatic compression of spinal vertebra. It involves the injection of bone cement into crushed vertebral body, which stabilizes it and reduces the pain by reducing movement at the fracture site. It is well established and straightforward to perform, usually as a day-care procedure.

IntroductionVertebroplasty is a minimally invasive, day care procedure used to treat vertebral compression fractures caused by painful osteoporosis and metastatic tumors. During vertebroplasty, A local anesthetic is used to numb the affected area of the patient's spine, where the surgeon inserts one or two needles guidance through a small incision in the patient's skin. Under under C- arm, the surgeon inserts the needles into the fractured vertebra through pedicals and slowly injects a small amount of bone cement into the vertebra at fracture site. The bone cement hardens quickly. The patient is kept for observation for a few hours following the procedure. In rare cases, the patient is kept overnight for observation.Vertebroplasty can prevent further collapse of the vertebra, height loss and spine curvature.

. During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae. 2. Using X-ray images, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.3. The balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (). After being injected, the pasty material hardens quickly, stabilizing the bone. Kyphoplasty surgery to treat a fracture from osteoporosis is performed at a hospital under local or general anesthesia. Other logistics for a typical kyphoplasty procedure are: The kyphoplasty procedure takes about one hour for each vertebra involved.Patients will be observed closely in the recovery room immediately following the kyphoplasty procedurePatients may spend one day in the hospital after the kyphoplasty procedure Patients should not drive until they are given approval by their doctor. If they are released the day of the kyphoplasty surgery, they will need to arrange for transportation home from the hos

Vertebroplasty and Kyphoplasty are similar medical spinal procedures where bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving the pain of vertebral compression fractures (VCF). When a vertebral body fractures, the usual rectangular shape of the bone becomes compressed, causing pain. These compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous, and vulnerable to breaking. Vertebrae may also become weakened by cancer. In vertebroplasty, physicians use image guidance to inject a cement mixture into the fractured bone through a hollow needle.

Patients with osteoporosis are prone to compression fractures in the spine bones, or vertebrae. The front of a vertebra cracks under pressure, causing it to collapse in height. More than 700,000 such fractures occur every year in the United States. These fractures often cause poor back posture, debilitating pain, and difficulty completing routine activities.Vertebroplasty restores the strength of the fractured bone, thereby reducing pain. More than 80 percent of patients get immediate relief of pain with this procedure.RationaleWhat do surgeons hope to achieve?In the past, surgeons used standard open surgery to fix compression fractures from osteoporosis. Open surgery requires larger incisions to give the surgeon more room to operate. The results of open surgery for this condition have generally been poor, mainly because it is difficult to do surgery on bones that are weak and soft from osteoporosis. In addition, some aging adults with fractures may not be physically able to tolerate such surgery.Vertebroplasty gives surgeons a way to fix the broken bone without the problems associated with open surgery. Unlike open surgery, vertebroplasty is a minimally invasive procedure. It requires small openings in the skin and small instruments. This lessens the chance of bleeding, infection, and injury to muscles and tissues.Surgeons fix the bone in place by squeezing special cement into the broken bone. The cement strengthens and stiffens the vertebra, which reduces pain considerably and helps the patient return to normal activities.This procedure doesn't restore the original height of the broken vertebra, however. Nor does it prevent the kyphosis (hunchback) deformity that sometimes results from compression fractures.

The vertebral column or backbone tends to get weak as a person gets old. This is more common in women since female hormones are necessary for normal mineralization. The weak bones in the spine collapse, producing painful fractures. Till a few years ago the only treatment that was available for condition was a major surgery. However thanks to interventional radiology today a fractured bone of the spine can be strengthened by injecting a specialized medical cement ( bone cement) into the diseased vertebral body. The vertebral column or backbone tends to get weak as a person gets old. This is more common in women since female hormones are necessary for normal mineralization. The weak bones in the spine collapse, producing painful fractures. Till a few years ago the only treatment that was available for painful fractures in the spine was a major surgery. However thanks to interventional radiology today a fractured bone of the spine can be strengthened by injecting a specialized medical cement ( bone cement) into the diseased vertebral body . If the patient suffers from back pain and the x-ray shows evidence of collapse of the vertebral body then the patient is evaluated for this procedure. The first thing would be to ascertain whether the pain is actually coming from this fractured bone. This is easily performed to by tapping on the vertebral column and ensuring that the bone that is fractured is the one that is painful. Once the pain has been localized to this bone, a MRI scan is performed to ensure that the fractured bone is not protruding into the spinal canal . This is extremely important lest the bone cement which will be injected produce further narrowing of the canal. This in turn can result in compression of the spinal nerve root producing further pain.

Our spine is made up of 33 vertebrae or spinal bones having a complex structure. Out of these 33 vertebrae, 7 vertebrae are in the cervical region, 12 in the thoracic region, 5 each in the lumbar and sacral region and 4 in the coccyx bone. Spinal bones or vertebrae in the sacrum and coccyx are fused together, whereas elsewhere these are individually separated from each other. Spine or the back bone in human beings provides the strength to maintain an erect structure. Human beings are the only species in animal kingdom that stands erect on two feet and hence the spinal column is so designed to maintain this configuration. Normally our spine is an S shaped structure with two primary and two secondary curves to attain an erect posture. Because of trauma (injury) or weak bones as in osteoporosis, the spinal bones or vertebrae can fracture and collapse, resulting in increase in curvature of the spine. The collapse can vary from mild to moderate to severe and in extreme cases can lead to injury or compression of the spinal cord with permanent damage to the neural structures and thereby permanent loss of functions in the body. Earlier the treatment of such cases was conservative with pronged rest leading to further weakening of bones (osteoporosis). Prolonged rest also leads to many hazards like increased risk of clot formation, thromboembolic sequelae, worsening of hypertension and diabetes, risk of bed sores and poor cardiorespiratory reserves etc. Latest research guidelines advocate immediate stabilization of the fractured bony segments and early mobilization. This can be safely achieved by introducing bone cement (PMMA) into the body of the vertebra through a thin pipe of the size of a thick needle under local anesthesia only. This procedure is done precisely under X-ray guidance in a fully equipped operation theatre. The cement solidifies in 10 minutes and the fractured bone stabilizes immediately with very good long term results. In cases where the vertebral height decreases more than 50%, the bone height is established by first inflating it with a balloon and then injecting the cement.

Vertebroplasty

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Vertebroplasty and Kyphoplasty

Vertebroplasty is a percutaneous procedure where liquid bone cement is injected into the fractured vertebral body producing pain.Vertebroplasty may be used for patients with vertebral compression fractures due to osteoporosis, metastatic tumors, or benign tumors such as vertebral heamangiomas.The procedure is done under conscious sedation. Prior to the start of the procedure, a prophylactic should be given intravenously. The patient is taken to the fluoroscopy suite and placed in the prone position on the operating room table with all pressure points padded and standard monitoring applied. Care is taken to add extra padding to the table due to the osteoporotic spine and risk of rib fractures. The level for the procedure is located in the posteroanterior fluoroscopic view. The fluoroscope is then rotated to an oblique position to maximize the oval appearance of the pedicle. Proper view is identified by seeing a "Scottie dog" appearance of the pedicle. It is important to "flatten out" the end plates of the verte bral bodies; if necessary, cephalocaudad or caudo cephalad fluoroscopic angle may improve the image. This will locate the pedicle well within the vertebral body in the fluoroscopic view. It is important to oblique the fluoroscopic view enough to place the facet joint in the middle of the vertebral body and the spinous processes to the contralateral side. This facilitates a central placement of the needle. The target for entry is the superior lateral quadrant of the pedicle in the fluoroscopic view. After the site of entry is identified, a skin is anaesthetized. A small skin incision is made with a No. 11 blade scalpel to allow insertion of a large bore biopsy needle. An 11 gauge bone biopsy needle is inserted through the incision. It is advanced in "gun-barrel" fashion in the oblique fluoroscopic view to monitor direction. The oblique view will show the needle shaft end-on as a circle within the center of the pedicle. Once contact has been made with bone, insertion through the cortex of the bone may be accomplished with a twisting motion of the needle or gentle tapping of the needle with a sterile hammer. It is important to "set" the needlepoint at the exact site of entry. In the lateral view, the needle needs to be at the upper midpoint of the pedicle so that the needle advances in the midpoint of the pedicle. The needle should follow a path that is parallel to the superior and inferior edges of the pedicle. The needle is advanced to the junction of the anterior and middle third of the vertebral body. After placement of the needle, the cement is prepared for injection. The amount to be mixed is based on the clinical observation of an average of 7 to 8 mL of cement injected in a lumbar vertebral body. The liquid monomer is titrated until it takes on toothpaste like consistency. There are several delivery systems available that may be used to simplify the mixing and delivery in addition to decreasing fumes. If these systems are not available, I-mL syringes may be filled and used one at a time to inject the cement into the ver tebral body. The injection of the cement is followed under fluoroscopic guidance in the lateral view. When the spread of the cement starts to invade the posterior one third of the vertebral body, injection should be stopped. The cement is 90% fixed at 1 hour.

This procedure is performed for osteoporotic spinal fractures not responding to conservative line of treatment, which includes rest, bracing, calcium supplements and anti-osteoporotic drugs. It is also useful in relieving pain of spinal metastases. However this procedure is contraindicated in presence of neurological deficit.The procedure is performed either under local or general anesthesia. A no. 10 Jamshedi needle is inserted under image guidance in the affected vertebra. Vetebroplasty cement which is a specialised bone cement available for this procedure is injected under image guidance. Patient is mobilised immediately after the procedure. This procedure offers excellent relief of pain. Complications of this procedure include extravasation of cement, neurological complications and embolism.

Verebroplasty is a treatment in which bone cement is injected through a small hole in the skin percutaneously into a fractured vertebra with the goal of relieving caused by vertebral compression fractures. Symptoms InfectionBleedingIncreased back painFracture of adjacent vertebra or ribsNumbness, tinglingParalysis

Kyphoplasty is a novel surgical procedure, which improves upon its predecessor, vertebroplasty. This procedure is usually performed in cases where there is a severe fracture of the vertebral body which causes it to collapse and decrease in height. The basic procedure of kyphoplasty involves a small incision on the back through which instruments are used to access the spine. The instruments are passed through the pedicle to reach the vertebral body. Upon reaching the fractured area, a special balloon

This Procedure is done for Vertebral fractures. Being minimally invasive, the procedure is the preferred mode of treatment for such patients.

Vertebroplasty

Vertebroplasty and kyphoplasty are minimally invasive procedures performed to treat vertebral compression fractures (VCF) of the spine. These fractures, which can be painful and limit spine mobility, are commonly caused by osteoporosis, spinal tumors, and traumatic injury.

Vertebroplasty

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