Section of Vascular and Interventional Radiology
Fractures of the spine are very common in patients with osteoporosis, the loss of bone mass makes the vertebra susceptible to fractures with minimal or no trauma. Some of these fractures can be very painful.
Vertebral fractures are usually managed with bed rest and analgesics, however, prolonged immobility can lead to severe complications such as clot in the veins of the legs and respiratory problems. If the traditional methods of treating your fractured vertebra or back pain fail, or you suffer from severe or prolonged pain or immobility, vertebroplasty may help you.
Vertebroplasty and kyphoplasty are usually performed on patients who:
- are elderly or frail and will likely have impaired bone healing after a fracture
- have vertebral compression due to a malignant tumor
- suffer from osteoporosis due to long-term steroid treatment or have a metabolic disorder
Vertebroplasty is a procedure that relieves pain and helps restore mobility after a fracture of the vertebrae in the spine. Using real time X ray monitoring, special needles are advanced inside the bone and cement is injected into the spine. The cement helps to stabilize the fracture. The procedure is done with sedation and local anesthesia with very small incisions in the back.
This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.
You will be seen in our outpatient clinic to discuss the risk and benefits of the procedures and review the images.
The day of the procedure:
A nurse will insert an intravenous into a vein in your hand or arm. Sedative medication will be given intravenously. The procedure is performed under moderate sedation, sometimes under general anesthesia.
You may be given medications to help prevent nausea and pain, and antibiotics to help prevent infection.
You will be positioned lying face down for the procedure on a special X ray (fluoroscopy) table.
The area through which the needles will be inserted will be shaved, sterilized with a cleaning solution and covered with a surgical drape.
A local anesthetic is then injected into the skin and deep tissues. A small skin incision is made at the site.
Using continuous x-ray guidance, the needle is advanced until its tip is precisely positioned within the fractured vertebra. You may feel a tapping sensation during the procedure as the trocar is advanced into the bone.
Medical-grade cement is slowly injected inside the fractured vertebra. The cement has a physical appearance that resembles toothpaste, which hardens soon after placement in the body.
In kyphoplasty, the balloon tamp is first inserted through the needle and the balloon is inflated, to create a hole or cavity. The balloon is then removed and the bone cement is injected into the cavity created by the balloon.
After the cement is injected, the needles are removed. The small incisions are covered with a bandage. No sutures are needed.
This procedure is usually completed within one hour. If there are multiple fractures, other vertebrae are treated during the same setting.
After the procedure:
You will be closely observed for 1-2 hours after the procedure for pain control and to detect any complications.
Approximately one hour after the procedure, you should be able to walk.
You may not drive after the procedure, but you may be driven home if you live close by.
You will be advised to increase your activity gradually. At home, you may return to your normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least four weeks.
It is normal to feel sored at the needle insertion site in your back for the next two or three days.
Pain relief is immediate for some patients. In others, pain is eliminated or reduced within two days.
Your interventional radiologist recommends a follow-up visit after your procedure or treatment is complete.
Complications are rare but possible and happen in 1 to 3% of procedures. Potential complications include hemorrhage, fractures of ribs or other nearby bones, fever, infection, irritation of nerve roots and cement flowing outside of the bone. A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem; rarely cement leakage moves into a potentially dangerous location such as the spinal canal or lungs blood vessels. Paralysis is extremely rare.
Around 75% of patient noticed significant improving in the pain, many patients restoring their mobility within few days. Approximately 10 percent of patients may develop additional compression fractures after vertebroplasty or kyphoplasty. Additional cement injections may be required in the future.
The Interventional Radiology group at UT Health Science Center in San Antonio has extensive clinical experience in these procedures and utilizes state of the art equipment to guide the procedures safely.
If you or on or your love ones has a vertebral fracture and needs a procedure, we will see you in our clinic and talk to you in detail about your options for treatment.
To schedule an appointment please call:
Perla Williams 210 358 2373
Otilia Merjil 210 3580420