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Success of Repeated Percutaneous Vertebroplasty
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Posted on: 11/30/1999
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If you have a vertebroplasty procedure for a vertebral compression fracture (VCFs) and it doesn't relieve the pain, should you have it done a second time? That's the question the authors of this study asked.
Vertebroplasty is a minimally invasive medical procedure. A tiny incision is made in the skin over the fractured vertebra. This is called a percutaneous vertebroplasty. Bone cement is injected through the incision into the affected vertebra. The goal is to stabilize the bone and reduce pain caused by the fracture.
Repeat vertebroplasty was done in 15 patients who had continued painful osteoporotic VCFs. The second percutaneous vertebroplasty was done as early as four days after the first one. Some repeat injections were done up to 32 days later.
Complete pain relief was achieved in 73 per cent of the patients receiving their second percutaneous vertebroplasty. The rest of the patients had at least partial pain relief. The authors reported that failure to fill the fractured vertebra with cement was the reason for the first failed procedure. Sometimes the cement reached the target area but there just wasn't enough to stabilize the vertebra.
Percutaneous vertebroplasty is quickly becoming the treatment of choice for painful osteoporotic VCFs. Successful management of the pain has been reported in many studies. Restoring vertebral height, strength, and stiffness results in pain relief. Proper technique is important to get good results the first time.
A second percutaneous vertebroplasty is an acceptable follow-up treatment if pain persists after the first one. This is true even if the persistent symptoms aren't caused by another (new) fracture.
The authors advise using a single injection of cement, making sure the needle reaches close to the midline of the vertebrae. Fluoroscopic guidance should be used to ensure accurate needle placement.
Fluoroscopy is a form of X-ray imaging that allows the surgeon to see real-time images inside the body. Enough cement must be used to fill the bone without overfilling, causing cement leakage. The patient can expect pain relief within 24 hours after the second vertebroplasty.
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References:
Shi-Cheng He, MD, et al. Repeat Vertebroplasty for Unrelieved Pain at Previously Treated Vertebral Levels with Osteoporotic Vertebral Compression Fractures. In Spine. March 15, 2008. Vol. 33. No. 6. Pp. 640-647.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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