Vertebroplasty

Vertebroplasty

What is Vertebroplasty?

Vertebroplasty literally means fixing the vertebral body. A metal needle is passed into the vertebral body and a cement mixture containing polymethylmethacrylate (PMMA), barium powder, tobramycin, and a solvent are injected under imaging guidance by the physician. The cement hardens rapidly and buttresses the weakened bone. The barium makes the cement visible on x-ray and the tobramycin is an antibiotic. The procedure was originally developed in France in 1984 and has been further refined in the US since 1995.

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.

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.

When the needle is in appropriate position, a small test injection with x-ray contrast is performed to ensure that a vein has not been entered.

This prevents the inadvertent passage of cement into a vein and embolization to the heart and lungs. The needle is repositioned if necessary and the cement mixture is slowly injected during constant x-ray monitoring. When the potential spaces within the vertebral body are filled, the needle is slowly removed and the other half of the vertebral body is then filled with the cement.

It usually takes approximately 30-60 minutes to perform one level. More than one level can be performed if necessary during a single session. After the procedure, the patient is allowed to carefully ambulate and can usually go home within several hours. Most patients experience significant pain relief within the firsts 1-2 days. Many can stop their pain medications.