Let’s back up to what a vertebroplasty is actually an indication for. Our spinal vertebrae are pretty thick bones, but even they can be fractured from a fall, trauma, or general osteoporosis (the bone is too weak/porous to support itself). When this happens, you may feel a focal, excrutiating pain in your spine, if severe difficulty in sitting up, or a chronic ache is the break is from osteoporosis. A Plain x-ray is usually done first that notices the fracture (and makes family docs freak out), but a CT or MRI is needed for further investigation of the extent of the fracture. Luckily, when most vertebrae fracture, the cracks stay internal rather than chips of bone going into your whole body. Internal cracks can be cemented back together with a procedure called a vertebroplasty.
If a vertebrae is not repaired, there is about a 60% chance that the vertebrae above and below the fracture will also break in the next year. A vertebroplasty is performed in hospitals and ambulatory surgical centers by radiologists, or anesthesiologists/physiatrists that specialize in pain management. If done outside of a hospital the patient goes home the same day. The patient lies face down on a table and given sedation to make them comfortable (I have seen some snore through the whole procedure). During this time, a C-arm x-ray machine continuously takes pictures of what is going on. The doctor places a trochar (this looks like a drinking straw) on the back and makes a small incision (about 10mm) to push the trocar through. Under x-ray you can see this go all the way to the bone where a small mallet (yes, kind of like a hammer) is used to drive the trochar in the bone. Once in the middle of the vertebrae, a liquid cement is run down through the trochar, filling the cracks with cement. This cement polymer hardens within a few minutes, but the patient has to lie down for about 2 hours afterwards as a precaution. After the cement the trochar is removed and a few simple stitches are placed over the incision site. The site is so small you can usually not find it after a few months. The entire procedure takes about 20 minutes on average, and after lying flat for two hours the patient goes home. There are no major limitations afterwards because the bone has already been cemented/hardened.
Who should not have a vertebroplasty? Fractures that have chips coming out of the bone (burst fractures) risk pushing the chip into something vital like the aorta. Also, people who are displaying signs of nerve damage to the low back (loss of sensation or muscle of the legs, loss of bowel control). A vertebroplasty does nothing for nerve damage, only bone. Complications to a vertebroplasty are around 1%, the most common being radicular/nerve pain (from irritation by the trochar) and rib fracture.
With such a low complication rate, and the face that a large number of these are done without hospital admission, a vertebroplasty is good decision for a compression fracture for a large number of people. A large number of people feel a significant amount of relief immediately after it is done, aside from some soreness of the trocar going into the body. And at the risk of ignoring it, it is a recipe for further fractures and ultimately, further vertebroplasties.
