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Vertebroplasty

Compression fractures are a common consequence of osteoporosis, where weakened bones are prone to breaking even under minimal stress. These fractures can occur in the vertebrae, leading to severe pain and reduced mobility. An osteoporotic compression fracture can significantly impact quality of life, often necessitating treatment to manage symptoms and prevent further fractures.

Our UF Health pain medicine experts are highly skilled in a number of minimally invasive procedures including vertebroplasty which can be used as a treatment for a painful vertebral compression fracture. Most people who have this procedure have less pain and a better quality of life after the surgery. They often need fewer pain medicines and can move better than before.

What is vertebroplasty?

Vertebroplasty, also known as percutaneous vertebroplasty, is a minimally invasive procedure which is used to treat painful compression fractures in the spine. Compression fractures occur when bones in the spine weaken, often as a result of osteoporosis, causing all or part of a spine bone to collapse. This may lead to a more severe form of compression where the entire vertebral body, the front section of the vertebra, collapses. The vertebroplasty procedure is often done as an outpatient procedure.

During a vertebroplasty procedure, medical-grade cement is injected into a collapsed section of vertebra, providing support and alleviating pain.

Because percutaneous vertebroplasty can be performed with a needle, no incision is needed for this minimally invasive procedure.

This procedure is similar to kyphoplasty. However, kyphoplasty involves the use of a balloon that is inflated at the end of the needle to create space for the cement between the vertebrae.

How is a vertebral compression fracture diagnosed?

Vertebral compression fractures can occur suddenly and cause severe pain. The fracture pain is most commonly felt in the middle or lower spine but can also be felt on the sides or in front of the spine. The pain is sharp and can be disabling and take weeks or months to go away on its own.

Spinal compression fractures can be diagnosed using X-rays, CT scans, or MRI scans. These scans are used to diagnose both the severity and exact location of the fracture, which helps determine whether vertebroplasty may be a viable course of treatment.

When should you have the procedure?

Your pain medicine specialist may recommend this procedure if you have severe and disabling pain for two months or more that does not get better with conservative measures such as bed rest, pain medicine, and physical therapy.

This procedure may also be recommended if you have a painful vertebral fracture due to cancer, including multiple myeloma, or if you’ve had an injury that caused broken bones in the spine.

How does the vertebroplasty procedure work?

The vertebroplasty procedure is done in a hospital or outpatient clinic, usually under local anesthesia. This means an anesthetic will be applied to the specific area of your body near the damaged vertebra, numbing the location so you will not feel pain. You will be awake during the procedure, though you may also be given medication to make you relaxed and sleepy.

If you are put under general anesthesia, you will be asleep and unable to feel pain during the procedure.

During the procedure, a type of needle called a trocar is placed through the skin and into the affected spine bone. Real-time X-ray images are used to guide your doctor to the correct area in your lower back.

Medical-grade bone cement is injected into the broken spine bone. The cement quickly hardens, stabilizing the fracture and providing pain relief.

The entire procedure lasts around an hour, though it may take longer for patients with multiple fractures that need to be addressed.

Vertebroplasty is generally performed as an outpatient treatment, which means you will probably go home on the same day of surgery. You should not drive, unless your provider says it is OK. Your doctor will tell you whether you need to stay overnight.

What are the risks of vertebroplasty?

Vertebroplasty is generally safe and has a low rate of complications. However, the procedure—as with all medical procedures—has risks that patients should be aware of before deciding on a course of action. Complications may include:

  • Bleeding
  • Infection
  • Blood clots
  • Allergic reactions to medicines
  • Breathing or heart problems, if you have general anesthesia
  • Nerve injuries
  • A temporary fever or increase in pain due to postoperative inflammation
  • Leakage of the bone cement into surrounding areas (this can cause pain if it affects the spinal cord or nerves). This problem is more common with this procedure than with kyphoplasty. You may need spine surgery to remove the leakage if it occurs.

Your doctor will discuss potential complications with you in more detail before you choose this procedure.

What to know before the procedure

Following pre-procedure instructions is an important way that you can help your physician lower the risk of complication and maximize the chance of successfully reducing or eliminating your symptoms.

Always tell your provider:

  • If you are or might be pregnant
  • What medicines you are taking, including those you bought without a prescription
  • If you have been drinking a lot of alcohol

During the days before the procedure:

  • You may be asked to stop taking aspirin, ibuprofen, coumadin (Warfarin), and any other medicines that make it hard for your blood to clot several days prior to the procedure
  • Ask your doctor which medicines you should still take on the day of the surgery
  • If you smoke, try to stop

On the day of the surgery:

  • You will most often be told not to drink or eat anything for several hours before surgery
  • Take the medicines your provider told you to take with a small sip of water

What to know after the procedure

Following all postoperative instructions from your healthcare provider is an important way to speed your recovery time and lower the risk of complications.

  • If you have soreness at the spot where the needle was inserted, apply ice to the area
  • While some patients experience immediate pain relief, others have an increase in pain for a short period of time due to inflammation at the injection site. Your doctor may prescribe over-the-counter medications to address this temporary pain
  • You should be able to walk. However, it's best to stay in bed for the first 24 hours, except to use the bathroom
  • After 24 hours, slowly return to your regular activities
  • Avoid heavy lifting and strenuous activities for at least 6 weeks

Sources used:

Percutaneous Vertebroplasty and Kyphoplasty

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