Name of the Procedure:

Percutaneous Vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral

Summary

Percutaneous vertebroplasty is a minimally invasive procedure designed to stabilize a fractured vertebra of the lumbosacral spine using bone cement. It also allows for a bone biopsy if needed. The procedure uses imaging guidance to ensure precise delivery of the cement.

Purpose

The main objective is to alleviate pain and stabilize vertebral fractures caused by conditions such as osteoporosis, spinal tumors, or traumatic injuries. The expected outcome is reduced pain and prevention of further vertebral collapse.

Indications

• Severe, persistent back pain due to vertebral compression fractures
• Osteoporotic vertebral fractures that do not respond to conservative treatment
• Vertebral fractures due to malignancies
• Traumatic vertebral fractures
• Unstable vertebral bodies causing potential spinal cord compression

Preparation

• Fasting for at least 6-8 hours prior to the procedure
• Adjustments or temporary discontinuation of certain medications such as blood thinners
• Pre-procedure imaging studies like X-rays, MRI, or CT scans to locate the fracture and plan the procedure
• Blood tests to check coagulation status and other relevant health parameters

Procedure Description

1. The patient is positioned face down on the operating table.
2. Local anesthesia or light sedation is administered to minimize discomfort.
3. Using fluoroscopic or CT imaging guidance, a needle is inserted through the skin into the fractured vertebral body.
4. Bone cement is carefully injected into the vertebral body to stabilize the fracture.
5. Bone biopsy samples may be taken if necessary.
6. Imaging is used to ensure appropriate cement placement.
7. The needle is withdrawn, and the puncture site is bandaged.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Percutaneous vertebroplasty is commonly performed in a hospital's radiology or surgical suite, or in an outpatient surgical center equipped for such procedures.

Personnel

• Interventional radiologist or spine surgeon
• Nurse(s)
• Radiology technician
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection at the injection site
• Bleeding
• Cement leakage, possibly leading to nerve or spinal cord compression
• Increased pain or new fractures
• Allergic reaction to materials or medications used
• Rare complications include pulmonary embolism or stroke

Benefits

• Significant and rapid pain relief
• Stabilization of the fractured vertebra
• Improved mobility and ability to perform daily activities
• Prevents further collapse of the vertebral body

Recovery

• Patients are typically observed for a few hours post-procedure.
• Mild discomfort or pain at the injection site is common and generally managed with over-the-counter pain medication.
• Avoid heavy lifting or strenuous activity for a few days.
• Follow-up appointment for a clinical and imaging evaluation to assess the success of the procedure.

Alternatives

• Conservative treatments: Pain medication, bracing, physical therapy
• Kyphoplasty: A similar procedure that includes balloon inflation to create a cavity for cement
• Open surgical stabilization: For severe or complex fractures
• Pros and cons: Conservative treatments have lower immediate risks but may be less effective; kyphoplasty and open surgery are more invasive but may offer additional benefits in specific cases.

Patient Experience

During the procedure, patients might feel slight pressure or discomfort. Post-procedure, mild soreness at the injection site can occur but is typically transient. Pain relief can be immediate or occur within a few days, significantly enhancing the patient's quality of life. Pain management strategies and supportive care are readily available to enhance comfort.