Osteoporosis

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Surgical Treatment

Vertebroplasty

Vertebroplasty is a minimally invasive procedure used to reinforce vertebrae with compression fractures, which are common in patients with osteoporosis. Vertebroplasty involves injecting an acrylic compound into the collapsed vertebra to stabilize the weakened bone. The procedure is performed in an operating room or radiology suite and treatment of each affected vertebra takes approximately 1 hour.

Local anesthesia is injected into the vertebra, a small incision is made, and a bone biopsy needle is inserted. Several small syringes of the cementing material are then injected through the needle into the vertebra. The cement hardens almost immediately.

Approximately 70–90% of patients experience pain relief after vertebroplasty and most are released from the hospital the same day. Anti-inflammatory medicine (e.g., Motrin®) may be used to relieve pain after the procedure.

Complications from the procedure are rare. Bone cement may enter the lung, spinal cord, or epidural space surrounding the vertebra. Other possible complications associated with vertebroplasty include nerve irritation, punctured lung (pneumothorax), and spinal cord injury.

Kyphoplasty

Multiple spinal compression fractures caused by osteoporosis may lead to height loss, kyphosis (extreme curvature of the spine), and pain. Kyphoplasty, also called balloon kyphoplasty, is a minimally invasive procedure that is used to restore the height of the vertebrae and stabilize weakened bone. Kyphoplasty cannot correct established spine deformities and is used in patients who have experienced recent fractures (within 2–4 months). The procedure is usually performed in the hospital under local or general anesthesia and takes approximately 1 hour for each affected vertebra.

In balloon kyphoplasty, a small incision is made and a fluoroscope (device that consists of a screen and an x-ray tube) is used to guide the insertion of a balloon catheter into the vertebra. The balloon is inflated slowly to raise the compressed vertebra, and then is deflated. An acrylic compound (cementing material) is then injected into the vertebra through a bone biopsy needle. The material hardens almost immediately. Pain relief usually occurs within 2 days.

Most patients are released from the hospital the day after kyphoplasty and can resume daily activities upon discharge. Strenuous activity, such as heavy lifting, should be avoided for at least 6 weeks.

Kyphoplasty complications are rare and include the following:

• Adverse reaction to anesthesia
• Cementing material may leak into veins or the epidural space surrounding the vertebra
• Nerve damage
• Spinal cord injury

In a newer, minimally invasive procedure called vesselplasty, an artificial vessel (Vessel-X®) is used instead of a balloon catheter. Studies have shown that vesselplasty reduces the risk for leaking of the cementing material. Ongoing research and testing involving this procedure is being conducted.

Osteoporosis, Surgical Treatment reprinted with permission from womenshealthchannel.com
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