Vertebral augmentation is a general term for several procedures used to stabilize the interior of a damaged spinal bone (vertebra). These procedures go by names that include vertebroplasty, kyphoplasty, radiofrequency ablation and controlled ablation (coblation). Vertebroplasty and kyphoplasty are the main forms of vertebral augmentation, while radiofrequency ablation and coblation sometimes play supporting or secondary roles during augmentation.
Most people who undergo vertebral augmentation have damage in the main bodies of their vertebrae caused by the advancing effects of the brittle bone disease osteoporosis, or by the onset of a tumor that originates locally or spreads to the spine from some other part of the body. Both osteoporosis and spinal tumors can produce injuries called compression fractures, which are characterized by internal crumbling of the affected bone(s). In turn, compression fractures can cause significant problems that include serious or debilitating pain, walking difficulties, a variety of nerve-related symptoms such as tingling and numbness, bladder or bowel incontinence, abnormal forward curvature of your spine and considerable reductions in your normal height. In addition to osteoporosis and tumors, you can develop compression fractures as a result of a traumatic back injury.
Details of the Procedure
Before performing a vertebroplasty or kyphoplasty, your surgeon will confirm the presence of a compression fracture with the help of an MRI (magnetic resonance imaging) scan or a CT (computed tomography) scan. At the start of the procedure, he will use additional imaging information from an X-ray machine called a C-arm fluoroscope to create a pathway through your skin to the targeted bone. When performing a vertebroplasty, your surgeon will then pass a needle-like device into the interior of the bone and inject it with a special form of cement. When this cement then dries, it stabilizes the fragmented pieces of the bone and holds them in place permanently.
When performing a kyphoplasty, your surgeon will first pass a small, deflated balloon into the interior of the damaged bone, then form an opening in the middle of the bone by inflating the balloon. This process effectively pushes the bone fragments together and restores some structural integrity. Once the opening in the bone is formed, your surgeon will deflate and remove the balloon, then inject the opening with the same type of cement used during the performance of a vertebroplasty. Again, the cement permanently stabilizes the bone when it hardens.
Radiofrequency ablation and coblation are procedures that use guided energy from radio waves to eat away, or ablate, various types of soft tissue. Surgeons uses these procedures to eat away tumors in the interiors of affected vertebrae prior to performing a vertebroplasty or kyphoplasty. This process, known as tumor debulking, can be very finely controlled and typically eliminates the tissue from a tumor without causing any other damage in the fragile interior of the targeted bone. Besides vertebroplasty and kyphoplasty, techniques sometimes used for vertebral augmentation include injection of natural bone or artificial bone substitutes, and use of a cutting device called an osteotome to prepare a bone for cement injection.
Benefits of the Procedure
Both vertebroplasty and kyphoplasty commonly lead to long-term stabilization of spinal bones damaged by compression fractures, regardless of the source of those fractures. These vertebral augmentation procedures also typically lead to significant reductions in a patient’s pain levels, reduce the need for pain medications, reduce reliance on canes or other supporting devices, and promote the return to a relatively normal level of physical activity. Use of these procedures can also help you avoid certain problems associated with enforced physical inactivity, such as diminished organ function and loss of muscle strength. For these reasons, vertebral augmentation can sometimes produce superior results when compared to more conservative treatment options for compression fractures, including bed rest and use of pain medications.
Risks of the Procedure
Potential risks associated with vertebral augmentation include leakage of cement from the targeted vertebra, accidental fracture of the rear portion of the targeted vertebra, leakage of cerebrospinal fluid, formation of a blood bruise or hematoma, formation of an abscess inside the spinal column, and stress-related changes in the vertebrae that sit above or below the repaired spinal bone. People who undergo an augmentation procedure in the thoracic spine (upper back) also run a risk for the onset of a collapsed lung. However, overall risks from vertebroplasty and kyphoplasty are relatively small. Most significant complications occur in people who have some form of bone cancer.
American College of Radiology: ACR-ASNR-ASSR-SIR-SNIS Practice Guideline for the Performance of Vertebral Augmentation
“American Journal of Neuroradiology”: Position Statement on Percutaneous Vertebral Augmentation…
North American Spine Society: Percutaneous Vertebral Augmentation
U.S. National Library of Medicine – MedlinePlus: Compression Fractures of the Back
Radiological Society of North America/American College of Radiology: Vertebroplasty & Kyphoplasty
Cedars-Sinai: Tumor Debulking – Coblation