Minimally invasive surgery is available for osteoporotic vertebral compression fractures: vertebroplasty (PVP), in which a “bone cement” is injected into the back of the diseased compressed vertebral body to restore height and stiffness by propping up the vertebral body with its contents, thereby relieving pain and restoring normal spinal mobility.
Nowadays, there are many patients with osteoporosis in outpatient clinics, most of whom are middle-aged and elderly women. Some of them have back pain, which cannot be relieved by injections and medications and seriously affects their daily activities. For these patients, there is a great possibility of vertebral compression fractures.
Often these patients are told that they need surgery during the previous treatment, but due to various considerations the patients do not want to undergo surgery. Now we introduce a treatment that can cure low back pain with a single “shot” and does not require general anesthesia, which is now the forefront of minimally invasive spine technology: vertebroplasty (PVP).
I. What is vertebroplasty (PVP)?
Percutaneous vertebroplasty (PVP) is a new technique that requires the injection of cement into the vertebral body via percutaneous puncture under the supervision of an image intensifier to treat osteolytic destruction and calcium deficient lesions of the spine. It is a simple, minimally invasive surgical procedure that provides an effective treatment for patients who suffer from spinal fractures and pain due to osteoporosis or tumors. The most commonly used bone cement is polymethylmethacrylate.
II. Several concerns about vertebroplasty
1. Image enhancement device “G-arm” and special surgical instruments
The G-arm can be used to guide the entry of the puncture needle, determine whether the puncture needle has entered the vertebral body accurately and check the amount and distribution of the bone cement injected into the vertebral body.
2.About the position The patient is in prone position
3.About anesthesia
Only local anesthesia is needed, and the patient only feels slight pain and discomfort during the operation. Usually 0.5%-1% lidocaine is applied. The skin, subcutaneous tissue and the periosteum of the bone at the puncture point through which the puncture needle passes need to be fully infiltrated with anesthesia to reduce the discomfort during the surgical operation.
4.Indications and selection criteria
At present, vertebroplasty is used for painful vertebral diseases, mainly for osteoporotic vertebral compression fractures, vertebral hemangioma, and palliative treatment of certain malignant tumors of the vertebral body.
① Pain symptoms are obvious, relying solely on drug therapy is not effective;
(ii) the pain is not due to other causes by imaging examination;
③The degree of compression of the vertebral body should be at least 1/3 of the original height of the vertebral body.
5.Effect of treatment
Pain relief: More than 70% of patients with metastases or myeloma achieve significant or complete remission after treatment, and more than 90% of patients with vertebral angiosarcoma in osteoporotic vertebral compression fractures with pain achieve significant or complete remission. Pain relief typically begins within hours or days after surgery, and even more patients have significant pain and improvement in limb movement immediately after surgery.
Enhancement of vertebral body strength: vertebroplasty can restore compliance of more than 1/2 of the compressed vertebral body, and the height of the vertebral body is significantly increased.
Third, change the stability of the vertebral body
With the accelerated aging of our population, osteoporotic thoracolumbar compression fracture is a common fracture in the elderly. For this kind of fracture, conservative treatment is bed-ridden for a long time, with many bed-ridden complications, and it is very likely to leave persistent back pain, accelerated degeneration of the adjacent vertebrae or even fracture in the long term.
For patients with previous cardiovascular, cerebrovascular, respiratory and other diseases, prolonged bed rest is a heavy blow to the patient’s physical condition. Vertebroplasty is gradually becoming the minimally invasive procedure of choice for the treatment of osteoporotic thoracolumbar compression fractures. Compared with traditional surgery, this procedure is less invasive, simple, and can significantly relieve pain, maintain vertebral body stability and restore vertebral body height. It is truly a “one-shot” treatment for osteoporotic vertebral compression fractures in the elderly.