Vertebral fractures are the most common fractures in patients with osteoporosis and account for approximately half of all osteoporotic fracture cases. They can occur without trauma or after minor trauma. Whether or not there is severe pain, osteoporotic vertebral compression fractures can lead to serious long-term problems. The risk of a new vertebral fracture is 5-10 times higher in patients who have one or more radiologically confirmed vertebral fractures than in others. Vertebral compression fractures are one of the complications of osteoporosis, and the goal of treatment is to restore the vertebra’s former biomechanical and physiological stability.

Percutaneous vertebroplasty (PV) is a minimally invasive treatment method in which a biomaterial (usually polymethyl methacrylate bone cement) is injected percutaneously into the fracture site to stabilize the fracture and relieve pain. PV was first performed in 1984 and today has become a widely used method worldwide for osteoporotic spinal fractures, neoplastic diseases of the spine, and spinal metastases.

Balloon kyphoplasty has been a guide for new developments in PV and in the treatment of osteoporotic spinal fractures in recent times. The balloon kyphoplasty technique, developed to address progressive kyphotic deformity resulting from osteoporotic spinal fractures, was first applied in 1998 and is a method that has yielded successful early results. In this method, which is performed percutaneously like PV, a balloon is placed into the fracture line, which reduces the fracture by inflating; after the balloon is removed, as in PV, the fracture is stabilized by addressing the kyphotic deformity with the injection of a biomaterial. Good results are obtained with this method, which aims to correct sagittal balance by restoring the height of the collapsed vertebra.

Indications:

Painful osteoporotic and osteolytic thoracolumbar vertebral fractures

Osteoporotic vertebral fracture patients whose pain does not subside after 3 weeks of non-surgical treatment

Patients with pneumonia, deep vein thrombosis, and analgesic intolerance who cannot be mobilized early

Primary osteolytic vertebral tumors (for diagnosis and treatment)

Metastatic vertebral tumors (for diagnosis and treatment)

Patients who complain of severe pain and who make lifestyle changes due to pain caused by the fracture are suitable candidates for vertebroplasty. The best results are generally obtained in cases with pain and tenderness on palpation in the area consistent with radiological findings. It is recommended that PV be performed within a few weeks after the fracture occurs. For PV to relieve pain, it is recommended to prefer cases with pain that can be localized to the fracture level, a spinal fracture shown on MRI to have occurred recently, and severe pain.

In patients with advanced osteoporosis, prophylactic cementing by vertebroplasty benefits not only the fractured level but also the adjacent segments. Thus, future refractures are prevented and patients’ quality of life is improved.

In performing the procedure, after the fracture is detected by MRI or CT, the patient is placed face down and sedated. Using an imaging method called “C-arm fluoroscopy,” the fractured vertebra is identified; after local anesthesia is applied, a cannula is inserted into the spine and bone cement is applied to this area. The cement hardens in 15-20 minutes, and after several hours of observation, the patient can be sent home the same night or the next day.

What is percutaneous vertebroplasty?

Percutaneous vertebroplasty (PV) is a minimally invasive treatment method in which a biomaterial (usually polymethyl methacrylate / bone cement) is injected percutaneously into the fracture site to stabilize the fracture and relieve pain. PV was first performed in 1984 and today has become a widely used method worldwide for osteoporotic spinal fractures, neoplastic diseases of the spine, and spinal metastases.

How is vertebroplasty performed?

After the fracture is detected by MRI or CT, the patient is placed face down and sedated. Using an imaging method called “C-arm fluoroscopy,” the fractured vertebra is identified; after local anesthesia is applied, a cannula is inserted into the spine and bone cement is applied to this area. The cement hardens in 15-20 minutes, and after several hours of observation, the patient can be sent home the same night or the next day.

What are the indications for vertebroplasty?

Is vertebroplasty a painful procedure?

During vertebroplasty, due to the heating of the bone cement (cement),

some degree of pain may occur. This pain can be controlled with analgesics.

After the procedure, the pain almost completely subsides.

What benefit will I get from vertebroplasty?

In spinal fractures, vertebroplasty is a very effective method when applied correctly. In vertebral fractures not treated with vertebroplasty, recovery with a brace and similar methods takes weeks, whereas after vertebroplasty, recovery is seen in a short time.

What is balloon kyphoplasty?

Which patients benefit more from vertebroplasty?

A fracture that has not collapsed much,

A fracture that occurred less than 3 months ago

A fracture older than 3 months, but still appearing active on bone scintigraphy, or where vertebral collapse occurred very recently

Patients with multiple fractures, severely collapsed fractures, and old fractures can of course also benefit from the method, but they benefit less than patients with the conditions described above. Patients who complain of severe pain and who make lifestyle changes due to pain caused by the fracture are suitable candidates for vertebroplasty.

When should vertebroplasty not be performed?

Pregnancy

Bleeding diathesis

Collapse of more than 50% in the thoracic region or more than 75% in the lumbar region

High-energy burst fractures and fractures of the posterior wall

Osteomyelitis

Epidural abscess

Allergic reactions to the substances used

When does pain go away after vertebroplasty?

In the majority of patients, pain decreases considerably or disappears completely within the first 24 hours after vertebroplasty or kyphoplasty.

How does vertebroplasty reduce pain?

It is not yet fully known how PV reduces pain. The reduction in pain may result from the mechanical stabilization achieved by bone cement injection. At the same time, it is thought that the heat generated during polymerization of the cement causes localized nerve cell death within the bone and/or at nerve endings, acting through receptors within the bone that transmit pain.

What are the advantages of vertebroplasty?

Particularly in elderly osteoporotic patients, it has important advantages such as sparing the patient from weeks or months of bed rest, the difficulties of brace-type applications and the other health problems they cause, and the difficulty of controlling long-lasting pain. Most patients treated with vertebroplasty and kyphoplasty state that their pain disappeared after the procedure.

What are the risks of vertebroplasty?

Like all surgical procedures, vertebroplasty or kyphoplasty interventions also carry some risks. Although these risks can be reduced in experienced hands, they can never be completely eliminated. For this reason, the patient should be told that complications such as infection, bleeding, contrast agent reaction, pulmonary embolism (blockage of the blood vessels in the lungs), chronic low back pain due to cement leaking into the disc space, rib or pedicle fracture, increased pain, and partial or complete paralysis (resulting from PMMA leaking into epidural or foraminal vessels) may occur. Various precautions are taken before and during surgery to prevent adverse outcomes. Thanks to these precautions, the likelihood of adverse outcomes can be greatly reduced, but it can never be completely eliminated. Remember that none of us give up riding in cars because of the possibility of a traffic accident.

This is entirely your own choice…

Vertebroplasty / Kyphoplasty