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Sacral Vertebroplasty Procedure

What does “Sacral Vertebroplasty” mean?

Here is the meaning of each word:

  1. Sacral: tailbone
  2. Vertebroplasty: to place something into a vertebra

What is a Sacral Vertebroplasty?

A Sacral 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) is injected.

Why is a Sacral Vertebroplasty done?

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

What is a Compression Fracture?

A is a fracture of the body of the vertebra. The vertebra typically looks like a wedge rather than a square when this type of fracture occurs. This is due to a collapse of the front part of the vertebra.

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 consistence comparable to 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 Sacral 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 Sacral Vertebroplasty procedure done?

Here are some of the steps of how this procedure is done:

  1. An intravenous catheter (IV) is started on the patient.
  2. Often patients get 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 tailbone area 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 straw like device (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 fractured body of the vertebra.
  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 straw 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 straw is satisfactory, PMMA is prepared and placed inside a syringe. Sometimes a material called “Barium Sulfate” is added to the cement. It may also be already in the PMMA to begin with. Barium Sulfate is material which can easily be 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 straws are taken out.
  13. Band-aids or a bandage are placed over the site where the metal straw 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.

What is the recovery like from a Sacral Vertebroplasty?

Here are some steps of the recovery from this procedure:

  1. This procedure is typically done as an outpatient.
  2. The patient is usually given restrictions on activity such as bending and lifting.
  3. The small skin punctures 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.

How long does it take to complete a Sacral Vertebroplasty procedure?

It may take about 30-60 minutes to complete this procedure.

What kind of benefit can I patients gain from a Sacral Vertebroplasty?

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