Vertebral compression fractures are often due to underlying osteoporosis (loss of bone mineral density) but may also result from spinal tumours. They can be a cause of severe back pain. Percutaneous vertebroplasty has become an established technique to relieve back pain due to recent spinal compression fractures. There may be an added benefit of preventing further loss in vertebral height at the same time.
There has been recent controversy regarding the effectiveness of vertebroplasty however it is our belief that it is effective in appropriately selected patients. The most recent evidence (VERTOS 2 study) is strongly positive for the procedure.
Pre-operative work-up entails demonstrating that the fractures are relatively new by MRI and/or bone scan and CT, thus making them a plausible cause for the patient’s pain. The procedure can be done on an outpatient basis and is performed with the patient positioned prone on the X-ray table. After infiltrating the skin with a local anaesthetic and administering intravenous analgesia and/or sedation to maintain patient comfort, needles are placed under X-ray guidance into the spine. Through these, fast-setting plastic bone cement is injected to reinforce and immobilise the fractured vertebral body. The cement is made visible on x-ray and the injection is carefully observed by x-ray to keep the injected cement within the vertebral body. Up to 3 levels may be treated at one session. The needles are removed immediately after the injection..
X-ray showing needle paths and cement at fracture site
Patients are observed for 2 hours afterwards and can be discharged home. Relief of back pain can be evident within hours and is often quite dramatic.