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Lumbar Vertebroplasty

What does “Lumbar Vertebroplasty” mean?

Here is the meaning of each word:

                         1. Lumbar: area of the spine located in the low-back

                         2. Vertebroplasty: to place material into a vertebra

Altogether, “Lumbar Vertebroplasty” means to place material into a broken vertebra of the low-back to help with pain.

What is a Lumbar Vertebroplasty procedure?

A Lumbar Vertebroplasty is a minimally invasive spine procedure. One or more small metal straws are placed into a fractured vertebra (compression fracture) and bone cement (poly-methylmethacrylate=PMMA) is injected.

Why is a Lumbar Vertebroplasty done?                        

A Lumbar Vertebroplasty procedure is done to help with the pain and instability of a vertebra from a compression fracture.

What is a Compression Fracture?

A compression fracture is a fracture of the body of the vertebra, which is the front part of the vertebra. When this fracture happens, the vertebra typically looks like a wedge rather than a square.

Compression fractures most commonly happen in patients with Osteoporosis. It often takes very little trauma such as bending forward, coughing or sneezing for a compression fracture to happen.

What is the difference between a Lumbar Vertebroplasty and a Lumbar Kyphoplasty?

The main difference between the two procedures is the use of a plastic balloon in the Kyphoplasty procedure. The balloon is placed through metal straws into the body of the collapsed vertebra. After the balloon is inflated, it can sometimes raise the collapsed vertebra and restore some of the lost height.

What is Bone Cement (poly-methylmethacrylate)?

Polymethyl-methacrylate (PMMA) is a commonly used bone cement. It is often used to secure a new hip (hip replacement) or knee joint (knee replacement) to the bones. PMMA comes as a semi-fluid with a consistency like soft cake batter. It can be injected through a syringe under pressure. Once it reaches the vertebra it begins to harden. Eventually it will have a similar consistency as the bone around it.

How does Bone Cement help a Lumbar Compression Fracture?

Once PMMA is injected into a vertebra it can stabilize the broken bone to avoid further collapse. This stability can lead to pain relief. PMMA also heats up as it hardens which can disrupt small nerve fibers which carry pain sensation. Another reason for pain relief is one of the chemicals in PMMA which can disrupt small nerves directly.

How is a Lumbar Vertebroplasty done?

Here are the steps for how a Lumbar Vertebroplasty is done:

  1. An intravenous catheter (IV) is started on the patient.
  2. Often patients are given antibiotics through the IV before the procedure.
  3. This procedure is done in a Procedure Room or Operating Room.
  4. The patient is initially placed on their back (supine).
  5. After a General Anesthetic is given, the patient is carefully placed on their stomach.
  6. The low-back (lumbar spine) is cleaned with a surgical antiseptic and sterile sheets (drapes) are placed around this area of the spine.
  7. With the help of an X-Ray machine, the doctor places a thin metal tube (trocar) into the pedicle of the vertebra (bridge between the arch and body of the vertebra) [link].
  8. The metal straw is then carefully pushed forward with the help of the X-Ray machine until it reaches the collapsed body of the vertebra. Often one metal tube is placed
  9. Sometimes contrast dye (fluid which looks dark on an X-Ray) is injected through the metal tube into the vertebra. This can show where the blood vessels of the vertebra are located. Vertebrae have many blood vessels on the inside. Some can be quite large. The doctor wants to know if the end of the metal tube is inside or very near to a larger blood vessel. This could mean that the bone cement might be injected into a blood vessel rather than the vertebra.
  10. Once the location of the tip of the metal tube is satisfactory, PMMA is prepared and placed inside a syringe. PMMA contains a chemical called “Barium Sulfate”. This is a material which can be easily seen on an X-Ray machine. Having it in the PMMA will let the doctor see the PMMA as it is injected into the vertebra.
  11. Again, with the help of the X-Ray machine, the PMMA is slowly injected into the collapsed vertebra. The doctor pays careful attention to the spread of the PMMA inside the vertebra.
  12. Once the injection is complete, the metal tubes are taken out.
  13. Band-aids or a bandage are placed over the site where the metal tubes was placed through the skin.
  14. The patient is turned on their back (supine) and awoken from Anesthesia.
  15. The patient is then brought to the Recovery Area for observation.

How long does it take to perform a Lumbar Vertebroplasty?

Typically a Lumbar Vertebroplasty takes 30-45 minutes to complete for one fractured vertebra.

What is the recovery from a Lumbar Vertebroplasty like?

  1. This procedure is typically done as an outpatient.
  2. The patient is given restrictions on activity such as bending and lifting.
  3. The small skin punctures from the metal tubes will heal within 7-10 days.
  4. The patient is often evaluated again by the doctor within several weeks. More X-Rays are often taken at that time.

What kind of benefit can patients gain from a Lumbar Vertebroplasty?

Most patients receive very quick pain relief, typically within 24 hours. This relief is typically for the long term.