Back Pain Relief Vertebroplasty For Compression Fractures

By Reza Ghorbani, MD, FIPP

Advanced Pain Medicine Institute

. http://www.advancedpainmedicineinstitute.com/

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Back Pain Relief Vertebroplasty For Compression Fractures

Vertebroplasty is the percutaneous augmentation of a vertebral body using polymethylmethacrylate (PMMA). PMMA was first introduced in 1970 for orthopedic use in total hip replacements. The first percutaneous vertebral augmentation using PMMA was done in 1984 in France. In the United States it was first introduced to treat compression fractures caused by osteoporosis in 1993. Since then, percutaneous vertebroplasty has become the standard of care for pain produced by osteoporotic compression fractures of the spine.
Vertebral fractures are the most common complication of osteoporosis. Age related osteoporotic compression fractures occur in more than 500,000 patients per year in the United States. This number is increasing because of aging population and an increase in the age-specific incidence of fractures and likewise in younger individuals with secondary osteoporosis. About 75 percent of patients with compression fracture are found to be suffering from persistent back pain symptoms.
Recent data reveal that vertebral compression fractures are associated with an increased mortality of 25-30 percent compared with age matched controls. Persistent pain that requires narcotic analgesics may be rapidly improved with this treatment.
It has also been used to treat compression fractures caused by malignancy. Vertebroplasty is performed to provide pain relief or to produce bone strengthening and vertebral stabilization when a metastatic or primary lesion threatens the stability of the spine. Radiation therapy may be performed in conjunction with vertebroplasty when the latter is performed for tumor lesions because cement injection does not prevent tumor growth.
Patients who seem to respond the best include those with single level or a few levels for treatment, fractures that present less than two months or a recent worsening of the fracture, and no significant sclerosis of the fractured vertebra. Recent MRI should be available, particularly a T2-weighted sagittal image and axial views through the levels of pathology to be treated.
Procedure
Percuteanous Vertebroplasty is done as an outpatient procedure, which is very convenient and highly cost effective. Patient is taken to the fluoroscopy suite and placed in the prone position on the operating room table. Sedative analgesics in the form of fentanyl, midazolam, or propofol are administered. Patients are monitored by standard anesthesia monitoring. Strict sterile technique is used and prophylactic antibiotics are given intravenously. The procedure may take up to an hour.
Afterwards the patient should be supine for two hours and then may sit for an additional hour in the recovery room. The cement is 90% fixed at one hour. The patient is then discharged home with routine pain medication and a gradual resumption of activity.
Vertebproplasty is a percuteanous procedure with a low complication rate that provdes immediate and long-term pain relief to patients suffering from chronic vertebral compression fracture pain. Although it remains important to provide conservative means of treatment including narcotics, adjunctive medication, and proper medical treatment of osteoporosis, vertebroplasty provides a minimally invasive procedure that may provide not only immediate relief but continued, prolong relief that may increase the patients daily activity level, which in turn helps provide a better quality of life.
In a study performed by Jensen and co-workers, immediate pain relief was reported in 90% of patients and long-term pain relief was reported in 80% of patients.
Reference “LOW BACK PAIN Diagnosis and Treatment” 2002. Manchikanti, etc al.