Vertebroplasty / Kyphoplasty / Sacroplasty

Figure 1. A typical lumbar compression fracture (white arrow)

Compression fracture of the vertebral body is common. It is defined as a vertebral bone in the spine that has decreased in height by at least 15% due to the fracture (Figure 1). It is more common in the lower spine (thoracic and lumbar). Some vertebral compression fractures may heal on their own. However, in most cases, the compressed vertebrae do not fully heal since the fractured vertebral fragments continue to move even with a back brace.

Vertebral compression fractures can cause severe back pain leading to inability to perform daily activities, and potentially social isolation due to immobility. It is known, particularly in women, that vertebral compression fractures are associated with a 15% higher mortality than those without. In order to prevent this ripple effect, we can perform a minimally invasive percutaneous interventional procedure that can stabilize the fractured bone with the use of cement. Depending on the lesion, we offer 3 types of interventional procedures; vertebroplasty, kyphoplasty, and sacroplasty.

During the procedure, the patient is lightly sedated and lies on their tummy. Under x-ray guidance, we place the needle into the vertebral body (Figure 2). Unlike most pain services where a relatively simple portable C-arm X-ray machine is used, we use the state-of-the-art biplane neuro-angiosuite, which is capable of 3-D navigation in the brain and spine (Figure 3). In rare occasions, placement of the needle is challenging due to previous implantation of metal hardware that obscures the normal bony landmarks, or due to severe osteoporosis. The 3-D navigation capability provides us with the ability to very accurately place the needle without relying on the classic radiological bony landmarks (Figure 4).

Figure 2. A needle is placed into the fractured vertebral body under x-ray guidance.

Figure 3. The state-of-the-art biplane neuro-angio suite, which is capable of 3-D navigation in the brain and spine.

Figure 4. A needle is being placed into the vertebral body using the state-of-the-art 3-D navigation system, enabling very precise positioning of the needle without relying on classic bony landmarks that may become fuzzy in a patient with osteoporosis.

If there is a need to restore the height of the fractured vertebral body, a balloon is inflated within the fractured vertebral body prior to cement injection (kyphoplasty / Figure 5). Once the bone cement hardens, it becomes an internal cast and completely stabilizes the lesion (Figure 6).

Figure 5. Balloons are inflated within the fractured vertebral body in order to regain the height and also to create a cavity into which thick cement can be injected (Kyphoplasty).

Figure 6. The cement hardens in 10-15 minutes and completely stabilizes the vertebral body from the inside.