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Kyphoplasty, Vertebroplasty, Sacroplasty for Compression Fractures

Compression fractures occur in the spine when bones and vertebrae become soft and weak. Quite often the cause is osteoporosis which is marked by weakened and brittle bones and typically results in height loss and spine curvature. This kind of stress on the bones can cause painful compression fractures and further collapse of the bones. Using minimally invasive image-guided techniques, cement can be inserted directly into the fracture, creating an internal cast. The goal of such a procedure is pain relief.

Treatment

Kyphoplasty / Vertebroplasty
When compression fractures result in significant pain, physicians generally treat this medical condition with kyphoplasty or vertebroplasty. Both are minimally invasive, image-guided procedures that utilize bone cement to create internal casts. KYPHOPLASTY involves the placement of a balloon device into the fractured vertebra, which creates space for the internal cast of cement. VERTEBROPLASTY also utilizes X-ray fluoroscopy guidance, enabling radiologists to inject medical bone cement directly into the injured bone.

Sacroplasty
Sacroplasty is a minimally invasive procedure performed by an Interventional Radiologist using a CT scanner and a fluoroscopy “real-time” imaging to identify a fracture. Once identified, medical cement is injected to create an internal cast for the sacral insufficiency fracture. This procedure will take approximately an hour and is performed as an inpatient or outpatient procedure under local or general anesthesia.

Spinewand
The Spinewand procedure is performed with either vertebroplasty or kyphoplasty and requires either general or local anesthesia. Using the Spinewand targets the lesion, or tumor, directly to eliminate it from the vertebra. The Spinewand creates a very low temperature plasma field to vaporize the tumor, creating a cavity within the vertebral body. The energy from the plasma breaks molecular bonds of the tissue causing molecular dissociation.

Once the cavity has been created, the interventional radiologist fills in the cavity with bone cement to stabilize the vertebra. This creates an internal cast for previously unstable vertebra.

FAQ

What are the symptoms? Expand

Symptoms can include sudden and severe back pain, worsening of pain when standing or walking, some pain relief when lying down, pain and difficulty bending or twisting, loss of height and visible deformity or curvature of the spine.

How are compression fractures diagnosed? Expand

Compression fractures are diagnosed through physical exam and spinal X-ray, CT and/or MRI.

When is the Spinewand procedure needed? Expand

Vertebral Compression Fractures
Compression fractures take place when the vertebra weakens and then collapses. Compression fractures, like those due to osteoporosis, can be debilitating, create a poor quality of life, and cause immobility.

Metastatic Bone Disease
There are two types of metastatic bone lesions, osteoblastic and osteolytic lesions. Osteoblastic lesions increase bone density. These lesions do not change the strength of the bone but can decrease the stiffness of the bone. Osteoblastic lesions are common in prostate cancer patients.

Osteolytic metastases decrease bone density. The less bone density present in a particular area, the more fragile the bone becomes. These lesions can decrease the strength as well as the stiffness of the bone. Osteolytic lesions are common in patients with metastatic cancer and multiple myeloma.

Indications of Cavity Spinewand Expand

Indications include:

  • Painful Metastatic Lesions
  • Unstable Metastatic Lesions
  • Metastatic lesions with cortical disruption, especially posterior
  • Metastatic lesions with epidural extension
What should I expect? Expand

On the day of your treatment, you will change into a hospital gown and lie face down on an X-ray table. An IV will be placed and you may be given medicine to help you relax. Your back will be numbed with a local anesthetic.  Once your back is numb, a needle is inserted into your back.  A doctor guides the needle to the vertebral body to be treated. A cement-like material is injected into the damaged vertebral body. This is repeated for each vertebra that needs to be treated. The entire procedure may take over an hour, depending on how many vertebral bodies are being treated.  You can usually go back to your normal activities and eat the food you normally eat in about 24 hours.

For the Spinewand procedure, a majority of patients are given local anesthesia and light sedation. You will be placed on your stomach and a small incision will be made near the location of your tumor. The interventional radiologist will then advance a needle to the location of the tumor using “real time” image guidance, fluoroscopy. Once the Spinewand has been performed and the bone cement is in place, you will be moved to a recovery area.

Some patients will be on an outpatient basis and be free to return home the same day. Your doctor will make this decision prior to the day of the procedure. Most patients are able to return to normal activities within 24-48 hours following the procedure.

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