frequent procedures
 

VERTEBROPLASTY
Vertebroplasty is a procedure in which a collapsed vertebra (usually a wedge-shaped vertebral collapse) is assessed and if it meets the criteria for vertebroplasty, it is then accessed via a trocar through which liquid acrylic cement (polymethylmethacrylate - PMMA) material is injected into the vertebral body space and allowed to expand and correct to a significant degree the vertebral collapse that has occurred in the patient. The procedure was first done in 1984 by Jansen and Dion in the University of Virginia. This usually tends to result in significant and often near dramatic improvement in the patient's pain and symptoms that is not often relieved by other means. In addition spinal axial stabilization is achieved and function rapidly restored.

The actual technique in vertebroplasty requires fluoroscopic guidance and sometimes the use of a CT scan is added. Frequently, vertebroplasty technique can be used at the lumbar level or even the thoracic axial spine level with good results. in osteoporosi, vertebroplasy treatment is done in conjuction with medical treatment and use of post-procedure stabilizing corset.

INDICATIONS:
1. Traumatic vertebral wedge compression fracture.
2. Osteoporosis with wedge compression fracture (spontaneous).
3. Aggressive spinal heamangiomas.
4. Selected malignant spinal tumors.

CONTRAINDICATIONS: Osteolytic lesions with collapse associated with loss of vertebral posterior wall integrity as well as epidural invasion by tumors is a relative contraindication. Anticoagulated patients who are on Coumadin should stop Coumadin for about three days with the permission and knowledge of the prescribing physician. Other anticoagulants should also be stopped prior to starting this procedure. Aspirin should not be used in these patients for at least six to seven days before the procedure.

Patient's who are pregnant, or who suspect they may be pregnant, should not undergo any x-ray guided procedure like vertebroplasty. Radiation therapy of spinal tumors may be done before or after vertebroplasty. A young age is a relative contraindication.

COMPLICATIONS: Vertebroplasty can be a challenging procedure and may result in significant complications including worsened pain from inadequate distribution of the liquid acrylic cement, which could result from poor technique or poor localization of the injectate among others. Special precautions are needed at the thoracic level ( L1 vertebrae and above). Others include infection, bleeding, and allergy to contrast material.

SEDATION: Sedatives are often used, as well as analgesics, during this procedure. It is usually well tolerated.

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