Vertebroplasty/Kyphoplasty

Certain conditions may result in painful fractures of the spine and although these commonly result in pain, this is usually self limiting as the fractures heal themselves. The vast majority of osteoporotic fractures of the spine resolve without any form of intervention and in fact most osteoporotic fractures are not diagnosed as they never produce any symptoms.

Occasionally however, the pain persists beyond a reasonable period of conservative treatment with pain killers and anti-inflammatory medication and in these circumstances further intervention may be useful in helping to manage the pain and reduce the risk of future fractures around this level.

Intervention in the form of augmenting the vertebral bodies with a specialised form of bone cement (the same as used in hip or knee replacements) is advocated as a way of reducing pain and disability associated with osteoporotic vertebral fractures and in painful tumours or multiple myeloma of the spine. It is a minimally invasive procedure which should be performed by someone trained in performing these interventions and knowledgeable about the options available.

Typically these are performed by spinal surgeons or specialist interventional radiologist. There are a number of theories as to why cement augmentation may be useful. One of these is that the cement helps to stabilise the small fragments of bone around the fracture which reduces inflammation and allows the body to continue to heal itself.

The procedures themselves are briefly outlined below but the principles behind them are similar. They are to help with pain management and are particularly useful in painful osteoporotic fractures which have not healed or in painful spinal tumour metastasis in conjunction with other treatments usually specifically tailored to individual patients and their underlying condition.

Do all osteoporotic fractures need a vertebroplasty? Most osteoporotic fractures need little or no intervention and they will heal without treatment. To assess whether a fracture is likely to respond to cement augmentation, a set of facet joint injections (a much more straight-forward intervention) is carried out prior to considering vertebroplasty or kyphoplasty. Usually if the facet joint injections help the pain, then more intervention is not required

Vertebroplasty

This procedure is usually performed as a day case although occasionally a patient requires an overnight stay. This is usually performed under general anaesthetic but may be performed under local anaesthetic and sedation if patients can tolerate lying flat on their stomach’s for approximately 30 min.

A needle is passed under careful x-ray guidance from the back into the vertebral body where the fracture or tumour deposit lies. A liquid cement is then injected into the vertebrae while carefully noting where this is being distributed and then over the next 10-15min the cement sets. This can be repeated at up to 3 levels in each sitting.

Patients typically have some discomfort when the local anaesthetic has worn off but typically this is less than before the procedure and they are allowed up to walk around immediately. Further information may be found on the De Puy sponsored web site.

Kyphoplasty

This is essentially a very similar procedure except that a small balloon is placed inside the vertebral body and inflated. This compresses the bone to help healing and provides a small cavity which can accommodate the bone cement.

This has a potential benefit in reducing the amount of cement that may be distributed in places other than where it is intended. Some people also feel it may help to correct the deformity created by the fracture itself and so decrease the incidence to future fractures around the first fracture area.

This concept is debatable though and is likely to be a potential benefit rather than one we see in practice. It is a topic of much research. Your surgeon should be able to advise which procedure is to be considered in individual circumstances. In kyphoplasty a small balloon is used to create a cavity which can be filled with cement.

The balloon is removed and the void created may be filled with soft cement which hardens over 10-15 minutes. further information can be found at the medtronic sponsored company website for Kyphon.

Further info

• National Osteoporosis Society

• Myeloma UK