d. Vertebroplasty

Vertebroplasty

What is vertebroplasty and how does it work?

• Vertebroplasty is the injection of a substance called polymethylmethacrylate (PMMA) into a vertebral body to treat fractures or cancer metastases to the vertebrae.

In what cases is it applied?

• It is applied in cases of vertebral fractures.
• It can be used in cancer metastases.
• It is also applicable for patients with Multiple Myeloma.

What is the mechanism of action?

• Polymethylmethacrylate is a mixture of powder and liquid that, when mixed, forms a paste that quickly hardens to a bone-like consistency. A significant amount of heat is generated during the hardening process. This heat can destroy nerves within the vertebral body, leading to pain relief. It also stabilizes the fracture by essentially ‘gluing’ the broken area.
• For vertebroplasty to be feasible, the height of the vertebra should not be collapsed more than one third.

Vertebroplasty and the Applied Material

What preparations are required before vertebroplasty?

• Before the vertebroplasty procedure, ask your doctor to explain the method in detail. Your doctor will require written consent as mandated by law.
• Inform your doctor about any other medical conditions, medications you are taking, and if you have any allergies, including to drugs. Herbal medications such as vitamin E, glucosamine, garlic, and ginseng can also cause bleeding.
• Consult with your doctor about discontinuing any anticoagulant medications other than aspirin. • Bring all previous test results with you, such as MRI, computed tomography, and laboratory findings.
• Wear comfortable clothing and leave watches, rings, and other jewelry at home.
• Food and water intake should be stopped at least 4 hours before the procedure. However, medications for other systemic diseases can be taken with a small amount of water.
• Since sedation will be applied during the procedure, you will not be allowed to return home alone. You should come with a companion. Also, the local anesthetic used can cause temporary weakness and numbness in the legs, so you cannot drive.

How is vertebroplasty performed and how long does it take?

• Vertebroplasty is performed in an operating room setting. The patient lies face down. Mild sedation and local anesthesia are applied to the area of intervention. Under imaging guidance, a thick needle is directed into the fractured vertebra.
• Once it is confirmed that the needle is inside the vertebra, the paste-like material is injected into the vertebral body. This must be done within minutes before the material hardens.
• Afterward, the patient lies in this position for about an hour before being transferred to their bed. One day of rest is necessary.

Is vertebroplasty painful?

• There may be some degree of pain during vertebroplasty due to the heating of the paste. This pain can be managed with painkillers. The pain usually subsides completely after the procedure.

What benefits can I expect?

• When properly applied, vertebroplasty is very effective for spinal fractures. Patients recover quickly. Healing can take weeks with corsets or similar methods without vertebroplasty, but recovery is much faster after the procedure.

What are the side effects of vertebroplasty?

•  Vertebroplasty should be performed by trained spine surgeons, neurosurgeons, or pain specialists.
• If the material similar to the given paste leaks into the bloodstream, clots that can travel to the lungs may form.
•  If the paste leaks into the spinal canal where the spinal cord is located, it will harden very quickly, and immediate surgical intervention may be necessary.

In whom is vertebroplasty not applied?

• Vertebroplasty is not applied if there is a general infection or infection in the area, or if there are bleeding disorders. It should not be applied in cases where the spine is collapsed more than one third or in fragmented fractures.

Kyphoplasty

Kyphoplasty is an interventional technique used to treat painful vertebral compression fractures related to malignancy and osteoporosis. While vertebroplasty involves the injection of bone cement, typically polymethylmethacrylate (PMMA), into the vertebral body, kyphoplasty includes the placement of balloons into the vertebral body to create a cavity and to restore the height prior to the cement injection through an inflation/deflation process.

INDICATIONS

1. Compression fractures due to osteoporosis
2. Painful vertebral compression fractures related to primary and secondary tumors (such as myeloma, breast, prostate, lung, etc.)
3. Painful vertebral compression fractures with osteonecrosis (Kummel’s disease)
4. Chronic traumatic vertebral compression fracture without healing
5. Painful vertebral hemangioma in the vertebral body

CONTRAINDICATIONS

1. Asymptomatic vertebral compression fractures
2. Unmanageable coagulopathy
3. Systemic infection or local infection at the injection site
4. Allergy to polymethylmethacrylate (PMMA) and opacifiers
5. Prophylaxis in a patient with osteoporosis
6. Neurological deficits due to compression of the vertebra
7. Destruction and foraminal stenosis in the vertebra
8. Defect in the posterior wall of the vertebra
9. Myelopathy related to bone/canal retropulsion
10. Radicular pain
11. Vertebral compression fractures with >70% loss of height
12. Tumor extension into the spinal canal or epidural space

The procedure