Percutaneous vertebroplasty is a newer non-surgical technique
in which a medical grade cement is injected though a needle into
a painful fractured vertebral body. This stabilizes the fracture,
allowing most patients to discontinue or significantly decrease
analgesics and resume normal activity. Patients who are unresponsive
to conservative therapy of bed rest, analgesics, and back bracing
should be considered for vertebroplasty. Vertebroplasty is also
useful in painful or unstable benign and malignant vertebral lesions
that fail to respond to the traditional conservative therapies.
The success rate for this procedure in treating osteoporotic fractures
is about 90-95%. Vertebroplasty can effectively treat aggressive
hemangiomas of the vertebral body and may be palliative in patients
with malignant pathologic fractures. Significant complications
of the procedure are less than 1 percent. The first vertebroplasty
was performed in 1984 by French interventional radiologists for
treatment of a painful hemangioma in the cervical spine of a young
The diagnosis of vertebral compression fractures is usually need
X-Ray, history, physical examination & MRI or CT scanning
to determine if there is significant spinal canal compromise and
to exclude other causes of back pain.
The procedure is performed while the patient is awake but sedated,
and lying facedown so the interventional radiologist has access
to the back. The back is numbed by a local anesthetic, the procedure
is performed by an interventional neuroradiologist — a physician
with special expertise in the nerves, brain and spinal cord.
Through a small incision and guided by a fluoroscope, the neuroradiologist
passes a hollow needle through the spinal muscles and into the
fractured vertebra. X-ray cameras above, below and on the sides
of the table provide guidance for needle placement. When the needle
is in the correct position, bone cement is injected through the
needle into the vertebra. As a rule, the procedure takes one hour
for each vertebra that is treated.
After the procedure, patients lie flat on their backs for two
hours while the cement hardens. They are then discharged and can
resume normal activity. The majority of patients have significant
pain relief within a few days.
Indications for Percutaneous Vertebroplasty
1. Osteoporotic vertebral compression fractures causing moderate
to severe pain.
2. Painful metastasis and multiple myelomas with or without adjuvant
3. Painful vertebral hemangiomas
4. Vertebral osteonecrosis
5. Reinforcement of a pathologically weak vertebral body before
a surgical stabilization procedure.
Advantages of Vertebroplasty
1. Decreased pain. Vertebroplasty reduces and in some cases eliminates
the need for pain medication, and it also restores mobility in
2. Increased functional abilities. Vertebroplasty stabilizes
the fracture, decreases pain dramatically and allows a return
to the previous level of activity.
3. Prevention of further vertebral collapse. The cement fills
spaces in bones made porous by osteoporosis, strengthening the
bone so that it is less likely to fracture again.