MOD 3 - Vertebroplasty & Kyphoplasty

Vertebroplasty

• to stabilize fracture fragments and further prevent VB collapse and its associated pain in patients with pathological vertebral bodies by injecting acrylic cement into the VB

• does not restore the height and/or shape of the vertebral body, for those that require pain relief

Kyphoplasty

the use of a balloon catheter to expand a compressed vertebra to its near original height prior to cement introduction, thus restoring spinal curvature

Equipments

• specialized trocar needle (10-15 gauge)

• Syringes and needles (for local freezing)

• non-ionic contrast (site dependent)

• PMMA (polymethyl-methacrylate) and barium powder

• sedation medications, such as fentanyl

• local anaesthetic, such as lidocaine or bupivocaine

Risks

• leakage of cement before it hardens, leading to compression of adjacent structures

• nerve root irritation

• cement intravasation, leading to pulmonary embolism, which can lead to death (though this is very rare)

Indications

• chronic pain caused by compression fractures

• pain caused by other tumours (i.e. metastases)

• painful osteoporosis

• symptomatic vertebral angioma (benign tumours of a vessel)

Contraindications

• pharmaceutical allergies, such as cement, contrast media

• bleeding disorders

• infection

• lesions that extend into the spine

• patients with more than 5 metastases

• age: children/adolescents are not likely candidates

Where do copmression fxs typically occur

thoracic vertebral bodies, as well as the upper lumbar spine (L1)

Once the acrylic cement mixture is mixed when does it start to harden

after 5 mins

How is the specialized needle inserted into the vertebral body?

intra-pedicular