Anesthetic: Local with IV sedation in office; General anesthesia in the hospital
Vertebral compression fractures (VCFs) are a source of acute and chronic pain typically in the older population that can be extremely debilitating. Individuals will often complain of acute onset of severe back pain which can radiate down the arm, across the chest or down the leg. (See Vertebral compression fractures)
Today, 2 treatment options exist regarding the type of minimally invasive surgery used to treat VCFs: Vertebroplasty and Kyphoplasty. Both procedures involve injecting bone cement through a small hole in the skin (percutaneous) to help with the pain from the fracture. The difference is the technique in which this is performed. Vertebroplasty involves placing the cement in the fracture under high pressure conditions as the cement is being placed throughout the bone preventing further collapse of the vertebral body. Kyphoplasty is performed in a similar manner except the cement is placed after a cavity/hole is created inside the vertebral body. A balloon is inflated in the vertebral body which creates a cavity and allows for the potential of restoring the height of the vertebral body close to its normal level. The balloon is then removed and the cement is placed inside the void in a low pressure setting stabilizing the fracture.
We at VIPSC will determine which procedure is most appropriate for you depending on the type of fracture you have.
Contraindications/Reasons why you may not have your procedure today:
- Bleeding disorders/low platelet counts
- Medications that thin your blood (please review this section)
- Current infection
- No driver
- Your symptoms have changed and/or improved
- Patient refusal
- Procedure not approved by your insurance
- Poorly controlled high blood pressure that may be giving you symptoms
- Poorly controlled diabetes
- Allergies to the any of the medications that is being used
Potential side effects/risks of the procedure:
- Increased pain
- Allergic reaction
- Nerve and/or spinal cord injury
- Cement malplacement
- Adjacent level fractures
Complication rates for vertebroplasty and kyphoplasty have been estimated at less than 2 percent for osteoporotic VCFs and up to 10 percent for malignant tumor-related VCFs.
During the procedure, you will be lying on your stomach. An IV will be started to give you antibiotics prior to the procedure as well as sedation. An x-ray machine will be used to locate the specific level of the spine where the fracture is located. After your skin is cleaned with an antiseptic solution, typically betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement. Several areas on your skin is then numbed with a local anesthetic which is typically the most painful part of the procedure as this medicine has a tendency to burn when it is injected. After this point, you should only feel pressure. If anything is too painful for you, please tell your physician as more numbing medicine can be given. A very small incision is then made through the numb area on your skin. A probe is then placed through the incision landing on the level of your fracture. You may experience increased pressure in your spine as the trocar is advanced into the fracture. However, if at any time the pain/pressure is too intense, please tell your physician. The exact same procedure will likely be performed on the opposite side of your spine at the same fracture level. When the cement is placed and solidified, the trocars are removed. The cement hardens within minutes, strengthening and stabilizing the fractured vertebra. Several band aids are placed over each incision and the procedure is complete. You will likely not need any sutures.
Typical length of the procedure:
Approximately 30-60 minutes depending on what and how many levels need to be addressed. Expect to be at the clinic or hospital at least 2 hours after the start of the procedure. Please plan accordingly.
How long do you expect pain relief:
Typically, if all your pain is coming from the fracture, pain relief is instantaneous. Please keep in mind, however, that any pain coming from sources other than the fracture will likely not improve.