Vertebroplasty: Before and After the Procedure

What is a Vertebroplasty?
Vertebroplasty is a therapeutic percutaneous injection of bone cement into an acute compression fracture to provide stability and fast and enduring pain relief.

What does your patient need to do before the Procedure?
The patient will need evaluation to determine whether he or she is a suitable candidate for the procedure.  We will need to determine which level or levels are fractured and which is the symptomatic level or levels.  Also, the degree of collapse needs to be determined as well as whether there is bone retropulsion into the spinal canal.  The patient will need x-rays, an MRI scan, and sometimes a CT scan. If the patient is a suitable candidate for the procedure, we will also need blood tests to avoid problems with bleeding. The night before the procedure, starting at midnight, the patient should not eat or drink anything.

The patient should take the usual medicines on the day of the procedure. If the patient is taking insulin, the dose for the day of the procedure. Pain medicine should be withheld for at least 4 hours before the procedure. The anesthesiologist will administer appropriate medication for sedation and pain control during the procedure.

What happens during the procedure?
  The vertebroplasty is performed in our special procedures area under fluoroscopy by our specially-trained interventional radiologists and technologists.  The anesthesiologist or radiologist will provide sedation and analgesia.  The study is performed under local anesthesia under sterile conditions. Contrast media is then injected into the vertebra through the needles to make sure they are in good position. When good needle position is confirmed, cement is then injected until the vertebra has been filled. The cement does two things. First, it stabilizes the fracture. Second, the cement gets hot as it hardens; this heat is thought to destroy the pain producing nerve endings in the vertebra. The needles are then removed and the small needle holes are bandaged.

What can be expected after the procedure?
The patient will be taken to the recovery room and will stay in bed for 4 hours to let the bone cement fully harden. During this time they can have pain medication if needed. Usually, the patient will go home the same day and receive a prescription for pain medication. As with any surgical procedure, the patient will likely have some wound pain that will subside in four to seven days. The wounds should be kept clean and dry for at least five days. The patient will receive written instructions to follow at home. 

What are the Risks?
Any invasive procedure may have complications. The radiologist will discuss possible complications with the patient before the procedure.

One possible complication is allergy to the medicines or the contrast media. If the patient has a history of reaction to other iodinated contrast media, he or she can be premedicated with a corticosteroid prep.

Cement is injected into the vertebra during the procedure. Sometimes, the cement can leak outside the vertebra and press on nerve roots or the spinal cord. In addition, it can migrate to the lung. If these things happen, cement injection is stopped immediately and usually there are no problems; however, in a very small percentage of cases these adverse events can lead to worsened pain, paralysis, or require surgery to remove the cement. 

Any procedure that breaks the skin can result in bleeding or infection.

What about Exposure to x-rays?
Every precaution is taken to protect the patient from unneeded x-ray exposure.  While the risks of radiation are low from any single procedure, there is a risk benefit assessment made with any radiology exam or procedure.  If there is a chance that the patient is pregnant, we will need to know in advance.  The people involved in performing the procedure wear lead aprons to lessen the cumulative dose from daily exposure.

If you have any questions about this procedure, please feel free to contact us.

This procedure is performed by SDI Radiologists at St. Joseph's Hospital.