Thoracic Vertebroplasty

Osteoporosis is a "silent" disease characterized by weakening of bones, making them more susceptible to fractures, typically in the hip and spine. Elderly people and especially post-menopausal women are at greater risk of developing osteoporosis.

The mid to lower back area of the spine is mainly involved in weight- bearing, making these regions of spine more prone to collapse when bone weakness is present. This can lead to spinal (vertebral) compression fractures in these patients. Many of these vertebral compression fractures occur by minimal trauma or by no trauma at all. They can even occur while doing simple activities, like bending or twisting. Symptoms range from severe pain in the back, arms and legs to no pain at all. Most patients suffering from such a fracture may believe that their back pain is just a part of ageing, letting these vertebral compression fractures go undiagnosed. However, a single vertebral fracture significantly increases a person's risk of further fractures. When multiple fractures occur, it causes the spine to become rounded and bent forward resulting in loss of height and a hunchback appearance. This forward curvature of the spine negatively affects the quality of life of the patient and makes it more difficult for them to breathe, eat, walk, or sleep. Vertebral compression fractures can also occur in patients suffering from conditions such as metastatic tumor, multiple myeloma, and vertebral hemangioma.

Vertebroplasty is a minimally invasive procedure which is performed to reduce or eliminate pain caused by vertebral compression fracture. It stabilizes the fracture and prevents further collapse of the vertebra averting deformity. The vertebroplasty procedure involves injection of bone cement into the fractured vertebra under high pressure. The procedure is done under general or local anesthesia. You will be lying face down on the operating table. Your doctor will make a very small 1/2-inch incision in the skin over the fracture site. Under live X-ray guidance, a hollow needle called a trocar is introduced through the back and is positioned within the fractured vertebrae. Next, bone cement is injected into the area through the trocar under high pressure. After the vertebral body is filled completely with the bone cement, the needle is withdrawn before the cement hardens. X-rays or CT scans may be done to confirm the effective spread of the bone cement into the fractured vertebra. The skin incision is closed using steri-strips.

Contraindications

The procedure cannot be performed under the following situations:

• Compression fracture is stable and does not cause any pain
• A fractured fragment or tumour is present in the spinal canal
• Presence of a bone infection or bleeding disorder

Risks and complications

As with any surgery, some risks can occur. General complications include bleeding, infection, blood clots and reactions to anesthesia. The specific complications following a thoracic vertebroplasty include leakage of the bone cement into surrounding soft tissues or veins and damage to the spinal cord or spinal nerves leading to numbness or paralysis.