VERTEBROPLASTY

DR. MAHESHA. K
M.S.(ORTHO)., D.N.B. (ORTHO).,
Fellowship in spine surgery
ASST PROF ORTHOPAEDICS
YENEPOYA MEDICAL COLLEGE

HISTORY
First performed in 1984 by Galibert and
Deramond in France
C2 Vertebral haemangioma
15 gauge needle used
3ml of PMMA injected
Excellent pain relief

ANATOMY

APPROACHES

CERVICAL SPINE - ANTEROLATERAL

APPROACHES

THORACIC SPINE TRANSPEDICULAR

- PARAPEDICULAR

APPROACHES

LUMBAR SPINE - TRANSPEDICULAR

APPROACHES

SACRUM- TRNSPEDICULAR
PARAPEDICULAR
LATERAL

VERTEBRAL VOLUME ESTIMATES

Level Theorotical Fillable

50%compressed
volume (ml) volume (ml) volume(ml)
C5

7.2

3.6

1.8

T9

15.3

7.65

3.8

L3

22.4

11.2

5.6

INDICATIONS
RELIEF OF PAIN IN VCF ASSOCIATED WITH
1.OSTEOPOROSIS
2.MALIGNANCY
3.HAEMANGIOMA
4.KUMMELLS DISEASE
TIMING OF SURGERY

ANY TIME
- NO WAITING PERIOD

CONTRAINDICATIONS
1.ACTIVE INFECTION
2.BURST FRACTURES
3.VCF IN YOUNG PATIENTS
4.SIGNIFICANT STENOSIS
5.SIGNIFICANT NEUROLOGIC DEFICIT
6.HEALED or PAINLESS VCF
7.LACK OF EXPERIENCE/ FACILITY

CASE SELECTION
Determines the outcome
Correlate symptoms, signs and x rays
MRI or CT is not a must, but safer to have
Doubtful cases MRI /CT /Bone scan can be done
Hypointense marrow signal in T1 images Fracture
Informed consent

OT REQUIREMENTS
Aseptic OT
Radiolucent table
Biplanar imaging
11 gauge needles
Special cement (Vertebroplastic Depuy)
Syringes
Be ready for laminectomy

PROCEDURE
General/ Local anaesthesia
Prone position
Localisation under image
Stab wounds
Bipedicular approach
11 guage needles
Needles advanced to anterior half of the body
Take biopsy if indicated

PROCEDURE
If the needles are ok, mix the cement
Start injecting when the drop does not fall
Inject 2-5 cc of cement
Maximum three vertebrae in one sitting
WHEN TO STOP
1.Any extravasation
2.Filling of posterior third of the body
3.Adequate amount injected

PROCEDURE
Retain the needles with trocar until cement
begins to harden
Remove the needle
Close the skin
Patient can be mobilised without brace after 6
hours
No post operative antibiotics/ analgesics

OSTEOPOROTIC FRACTURES- D12 #

54 YEAR OLD LADY WITH 2 WK OLD INJURY

OSTEOPOROTIC FRACTURES D12

MULTIPLE COMPRESSIONS ?

MRI/ CT USEFUL IN IDENTIFYING

PAINFUL LEVEL D12

POST OP X RAYS

L1 FRACTURE WITH SEVERE COLLAPSE

CT & MRI

VERTEBROPLASTY L1

D12 FRACTURE

VERTEBROPLASTY D12

L2 FRACTURE

85+f, L1#

3 Months

Immediate post op x rays and patient

D12 FRACTURE

POST OP X RAYS

HEALED FRACTURES

VERTEBROPLASTY IN HEALED FRACTURES

NEVER DO THIS ! !

67 YEAR OLD MALE , BURST FRACTURE L1

CT & MRI RETROPULSION

- POSTERIOR WALL BREAK

TREATMENT OPTIONS?

VERTEBROPLASTY

RISKY BUT EXCELLENT OUTCOME IN EXPERT HANDS

POST OP AND FOLLOWUP

VERTEBRAL HAEMANGIOMA

VERTEBRAL HAEMANGIOMA

VERTEBRAL HAEMANGIOMA

VERTEBROPLASTY & POSTERIOR STABILISATION

COMPLICATIONS
1.Injury to spinal cord and nerve roots
2.Pneumothorax
3.Injury to blood vessels with hemorrhage
4.Pulmonary embolism
5.Infection
6.Extrusion of the cement
7.Fractures (ribs, pedicle)
8.Death

KYPHOPLASTY
Costly Marriage between vertebroplasty and
balloon angioplasty
Marketing jargon
ADVANTAGES
increase in vertebral height
Better correction of kyphosis
reduced cement leakage
Advantages are only marginal

KYPHOPLASTY
DISADVANTAGES
1.Costly (six times)
2.long learning curve
3.Need for general anaesthesia
4.Longer operating time
Disadvantages outweigh advantages

FUTURE DEVELOPMENTS
BIOCEMENT- CALCIUM HYDROXYAPETITE
USE IN YOUNG PATIENTS

THANK YOU