What causes vertebral fractures?

The spine is made up of bones called vertebrae that are linked together. When these bones become weakened, one or more can break and start to flatten out. This is known as a compression fracture.

Osteoporosis is the leading cause of vertebral fracture. Osteoporosis is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine, wrist, hip, pelvis and upper arm. In many affected people, bone loss is gradual and without symptoms or warning signs until the disease is advanced. When osteoporosis becomes severe, the vertebrae can easily fracture. Minor events such as coughing or sneezing may result in a fracture. Such fractures may go undiagnosed because the patient does not realize that his back pain may be due to a fracture.

What is vertebroplasty?

Vertebroplasty is a minimally invasive procedure involving injection of a cement into the fractured vertebral body to repair and strengthen the vertebra, prevent future fractures, and alleviate back pain.

How is vertebroplasty performed?

Prior to the vertebroplasty procedure, you will need to have a CT scan and/or MRI scan to confirm that you are a candidate for the procedure. Vertebroplasty is most effective on recent fractures, but is not effective on older fractures. You will also need to have blood drawn at the hospital or a local clinic to ensure that you do not have any blood clotting problems that may result in bleeding complications during the procedure.

The vertebroplasty in performed in the interventional radiology suite. You will be asked to lie on your stomach on the procedure table. The nurse will give you medication through an intravenous line in your arm to help you feel relaxed and drowsy. The Interventional Radiologist will then numb the affected area on your back. Using x-ray guidance, the Interventional Radiologist will advance a needle through the skin in the back into the affected vertebra. Contrast media (x-ray dye) is injected through the needle to see the venous drainage of the spine and ensure adequate positioning of the needle. Once the needle is properly positioned, a cement mixture of polymethylmethacrylate (PMMA), barium powder, tobramycin, and a solvent is slowly injected into the spine using x-ray guidance. It takes about 10 - 20 minutes for the cement to harden. The needle is then removed, and if necessary, the procedure may be repeated at other spinal levels. The procedure usually takes about 1 – 1.5 hours for each vertebra injected.

After the procedure, you will be taken to the recovery room and will stay in bed for 4 hours to allow the cement harden completely. Most patients go home the same day and receive a prescription for pain medication. Before you leave, the nurse will give you written instructions regarding care of the affected area.

Some patients experience immediate pain relief after the procedure. Most report that their pain is gone or significantly better within 48 hours. Many people can immediately resume their normal daily activities.

Discharge and Follow-Up Appointment Instructions

• You should rest for the remainder of the day and limit activity for the next 24 hours
• You may resume your normal diet
• You may drive 24 hours after discharge
• Take medications as directed. If you receive medications following the vertebroplasty that may make you feel drowsy, you should not:

-Operate a motor vehicle, machinery, or power tools
-Drink any alcoholic beverages
-Make important decisions, such as to sign any legal papers
-Perform any activity that requires physical coordination or mental alertness
-Take any additional sedatives

• Gradually decrease pain medication to take only as needed
• Remove bandage after 24 hours and clean area with soap and water
• After 24 hours, you may shower or bathe
• Observe the site for infection (redness, swelling, drainage, warmth)
• You may experience new back and hip discomfort due to an increased ability to move. Gradually increase your level of activity   over the next few days.
• Walking is encouraged
• Do not lift anything heavier than a gallon of milk
• Do not do any heavy lifting for 3 months. Then gradually increase your lifting to normal.
Immediately report the following symptoms or go directly to the emergency room:

Chest pain
Shortness of breath
Leg weakness or numbness
Severe back pain – if it is new
Unexplained fever

Schedule a 4 week post procedure follow up appointment with the Interventional Radiologist. Call the office at (305) 932-7800 to schedule the appointment.