Osteoporosis is a condition that causes the bones to become weak and brittle, making them more prone to fractures. One of the most common sites of fracture is the spine, where the vertebrae (the small bones that form the backbone) can collapse due to the loss of bone density. This can result in severe back pain, deformity, reduced mobility and quality of life.
Fortunately, there is a minimally invasive procedure that can help relieve the pain and stabilize the spine in some cases of osteoporosis-related compression fractures. It is called percutaneous vertebroplasty, and it involves injecting a special cement into the fractured vertebra through a small needle. In this article, we will explain what percutaneous vertebroplasty is, how it works, what are its benefits and risks, and who are the candidates for this procedure.
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What is Percutaneous Vertebroplasty?
Percutaneous vertebroplasty is a procedure that was first developed in France in the 1980s to treat painful vertebral fractures caused by tumors or other bone diseases. Later, it was adopted to treat osteoporosis-related compression fractures as well.
The procedure is usually done under local anesthesia or light sedation, and it takes about an hour to complete. The patient lies face down on a table, and the doctor uses X-ray guidance to insert a thin needle through the skin and into the fractured vertebra. Then, the doctor injects a liquid cement into the vertebra, filling the cracks and gaps in the bone. The cement hardens quickly, forming a cast that stabilizes the vertebra and prevents further collapse.
How Does Percutaneous Vertebroplasty Work?
The main mechanism of action of percutaneous vertebroplasty is mechanical. By restoring the height and shape of the fractured vertebra, the cement reduces the pressure on the surrounding nerves and soft tissues, which can cause pain and inflammation. The cement also acts as a splint that prevents further movement and damage to the bone.
Another possible mechanism of action is thermal. The cement generates heat as it hardens, which may destroy some of the nerve endings that transmit pain signals from the fracture site. The heat may also stimulate blood flow and healing in the area.
What are the Benefits of Percutaneous Vertebroplasty?
Percutaneous vertebroplasty has been shown to provide significant pain relief for many patients with osteoporosis-related compression fractures. According to Mayo Clinic, most patients report improvement within 48 hours of the procedure, and some experience immediate relief. The pain relief can last for months or years, depending on the individual case.
By reducing pain, percutaneous vertebroplasty can also improve mobility and function for patients with osteoporosis-related compression fractures. This can lead to better quality of life, independence, and mental health. The procedure can also prevent or reduce spinal deformity, such as kyphosis (a forward curvature of the spine), which can affect breathing, digestion, and appearance.
What are the Risks of Percutaneous Vertebroplasty?
Percutaneous vertebroplasty is generally considered a safe and effective procedure for osteoporosis-related compression fractures. However, like any medical intervention, it has some potential risks and complications. These include:
– Infection: There is a small chance of infection at the needle insertion site or in the vertebra itself. This can be prevented by using sterile technique and antibiotics.
– Bleeding: There is a small risk of bleeding from the needle puncture or from the fracture site. This can be controlled by applying pressure or using blood-clotting agents.
– Cement leakage: There is a possibility that some of the cement may leak out of the vertebra into the surrounding tissues or blood vessels. This can cause pain, inflammation, nerve damage, or embolism (a blockage of blood flow). This can be minimized by using appropriate cement volume and viscosity, and by monitoring the injection with X-ray.
– Adjacent fracture: There is a risk that injecting cement into one vertebra may increase the stress on the adjacent vertebrae, leading to new fractures. This can be avoided by treating multiple levels if needed, and by following up with osteoporosis medication and exercise.
Who are the Candidates for Percutaneous Vertebroplasty?
Percutaneous vertebroplasty is not suitable for everyone with osteoporosis-related compression fractures. It is usually reserved for patients who have:
– Severe or persistent pain that does not respond to conservative treatments such as painkillers, bed rest, braces, or physical therapy.
– Recent fractures (less than six months old) that are visible on X-ray or MRI.
– No signs of spinal instability, infection, or malignancy.
The decision to undergo percutaneous vertebroplasty should be made in consultation with a doctor who specializes in spine care. The doctor will evaluate the patient’s medical history, symptoms, imaging tests, and overall health status to determine if the procedure is appropriate and safe for them.
Conclusion
Percutaneous vertebroplasty is a minimally invasive procedure that can help relieve pain and stabilize the spine in some cases of osteoporosis-related compression fractures. It involves injecting cement into the fractured vertebra through a small needle, forming a cast that supports the bone and reduces nerve compression. The procedure can provide significant pain relief, improve mobility and function, and prevent or reduce spinal deformity. However, it also has some potential risks and complications, such as infection, bleeding, cement leakage, or adjacent fracture. Therefore, it is not suitable for everyone with osteoporosis-related compression fractures, and it should be done by a qualified and experienced doctor. If you have osteoporosis-related compression fractures and are interested in percutaneous vertebroplasty, talk to your doctor about the benefits and risks of this procedure, and whether it is right for you.
