Two new techniques and their modifications have been recently developed to achieve fixation of the spine after fracture. Long-term results are still being researched, and both techniques have the possibility of leading to side effects and complications. Before deciding on any type of intervention on the spine, discuss all options with your physician.
Vertebroplasty
Percutaneous vertebroplasty is a new technique that requires minimum amount of surgery and that can serve as an alternative in the management of osteoporotic fractures when conservative treatments are inadequate. Vertebraplasty enables strengthening the spine in patients with osteoporotic vertebral fractures, spine tumors or trauma.
What is the Technique?
After the diagnosis of vertebral compression fracture is confirmed with MRI or CT, the patient is placed in prone (facing down) position and is sedated with mild anesthesia. Under an imaging guidance named "C-arm fluroscopy", the doctor inserts needles through small cuts on the skin and injects a cement–like substance (polymethyl metacrylate) into the vertebral body.
The injection itself lasts approximately 10 minutes, while the whole procedure takes one hour. The cement mixture hardens in approximately half an hour, and the patient is followed at the ward until recovery from anesthesia, and subsequently discharged home either the same night or the following morning. Often patients are prescribed with analgesics to relieve the pain during the first few days.
When is Vertebroplasty Needed?
Osteoporotic patients are often old or have other diseases that carry surgical risks. Therefore vertebroplasty, a less invasive method, may be preferred over open surgery. Vertebroplasty does not correct bone loss due to osteoporosis, however it enables fixation of fractures.
The spine is the most common site for cancer spreading from other sites (metastasis). Spinal metastases in these patients may cause pain and fractures. Vertebraplasty provides spinal stabilization in these patients. It also decreases pain, and improves quality of life by increasing the ability to function.
Percutaneous vertebroplasty is a relatively new technique, and its long-term results are not exactly known. It stabilizes the spine by strengthening the broken vertebra in osteoporotic spine fractures and relieves the pain. On the other hand, osteoporosis is a systemic illness requiring systemic treatment. In patients with a fracture in any of the vertebrae, the development of a new fracture in vertebrae adjacent to the broken bone is five times greater than normal. Therefore, medical (drugs) treatment for decreasing the severity of osteoporosis must be initiated in these patients. Although the rate of complications is less than 1 percent, percutaneous vertebroplasty may cause infection, bleeding and embolism (obstruction of blood vessels) due to leakage of cement mixture into the bloodstream, followed by the heart and lungs. Consult your doctor about whether vertebroplasty is appropriate for you.
Kyphoplasty-Stentoplasty
Kyphoplasty is a newer technique that can be used in the treatment of osteoporotic spine fractures. It requires minimum amount of surgery. The strengthening of the spine is the main goal as in vertebroplasty. However, kyphoplasty offers the advantage of restoring the height of the collapsed vertebra. Therefore, it can address kyphosis (gibbosity) that develops due to fracture. Osteoporotic spine fractures often cause the front parts of the vertebrae to collapse, forming a wedge-shaped bone union. This condition results in pain, loss of height, and a gibbous appearance ("widow's hump,” or "dowager's hump”).
What is the Technique?
Kyphoplasty is a two-stage procedure. First, a baloon is inserted into the collapsed vertebra, and inflated to restore normal shape. Then, a cement-like substance (bone cement, polymethyl metacrylate) is filled into the space. This latter step enables preservation of the corrected shape. A more normal shape is given to the vertebra that can correct the alignment and shape.
Kyphoplasty is performed through a small cut in the back. Depending on the severity, it is performed under local or general anesthesia in the hospital. The whole procedure takes approximately an hour per each vertebra that is corrected. The patient is discharged the same or the next day. Disappearance of pain may be experienced within two days after surgery.Stentoplasty is a technique inspired by kyphoplasty. Atitanium expandable cage is used instead of a balloon. The cage is inserted in the vertebral body and expanded inside it. The collapsed bone is lifted this way and height is restored. The titanium cage is left inside—adventageous compared to the balloon technique. Since the balloons are removed in kyphoplasty, this may cause a re-collapse of vertebral body. However, in the stentoplasty technique, stents are left inside—preventing re-collapse. Finally, the vertebral body and the stents are filled with bone cement.
Kyphoplasty is a new treatment, and its long-term results are unknown. The effect of this treatment on neighboring vertebras is controversial. Similar to other interventions, kyphoplasty carries the same risks as vertebroplasty. Although it is stated that these side effects are less in kyphoplasty, there is no first level of evidence on this. Consult to your doctor and ask for information on these risks before you decide on treatment.