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Thoracic Vertebroplasty

What does “Thoracic Vertebroplasty” mean?

Here is the meaning of each word:

  1. Thoracic: area of the spine located in the mid-back
  2. Vertebroplasty: to place something into a vertebra

Altogether, “Thoracic Vertebroplasty” means placing something (bone cement) into a fractured vertebra of the midback.

What is a Thoracic Vertebroplasty procedure?

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

Why is a Thoracic Vertebroplasty done?

A Thoracic Vertebroplasty procedure is done to help with the pain from a compression fracture of a vertebra. A Thoracic Vertebroplasty procedure will also help bring stability to the vertebra.

What is a Compression Fracture?

A compression fracture 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 the collapse of the front part of the vertebra.

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

A Kyphoplasty procedure is essentially the same as a Vertebroplasty. The main difference between the two procedures is the use of a plastic balloon in the Kyphoplasty procedure. When the balloon is inflated in the broken body of the vertebra it could possibly raise the collapsed segment 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 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 Thoracic Compression Fracture?

When 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 that carry pain sensation. Another reason for pain relief is one of the chemicals in PMMA which can disrupt small nerves directly.

How is a Thoracic Vertebroplasty done?                                             

Here are the steps of how a Thoracic Vertebroplasty 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 place on their back (supine).
  5. After a General Anesthetic is given, the patient is carefully placed on their stomach.
  6. The mid-back (thoracic 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).
  8. The metal tube is then carefully pushed forward with the help of the X-Ray machine until it reaches the collapsed body of the vertebra. Often metal tubes are placed through both sides of the vertebra to be able to reach both sides of the fracture.
  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. Of course this is to be avoided.
  10. PMMA is now prepared and placed inside a syringe.
  11. One of the chemicals in PMMA is Barium Sulfate is material which can easily be seen on an X-Ray machine. Since it is part of the PMMA bone cement, the doctor can see the bone cement as it is injected into the vertebra.
  12. 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.
  13. Once the injection is complete, the metal tubes are taken out.
  14. Band-aids or a bandage are placed over the site where the metal tube was placed through the skin.
  15. The patient is turned on their back (supine) and awoken from Anesthesia.
  16. The patient is then brought to the Recovery Area for observation.

How long does it take to perform a Thoracic Vertebroplasty?

Typically a Thoracic Vertebroplasty takes about 30-45 minutes to complete for each vertebra.

What is the recovery from a Thoracic Vertebroplasty like?

Here are some of the steps in 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.

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

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