Vertebroplasty

Your doctor has requested that you have a vertebroplasty. We hope the following information will answer some of the questions you may have about this procedure.

What is a vertebroplasty?

Vertebroplasty is used to relieve the pain caused by compression fractures of the spine, which can be caused by osteoporosis, multiple myeloma or less commonly cancer and trauma. The procedure involves injecting a substance called “bone cement” into the vertebral body which can reinforce the weakened vertebral body and prevent further vertebral collapse. The cement is injected under x-ray guidance by the radiologist. 

Why do I need to have a vertebroplasty?

The purpose of vertebroplasty is to stabilise the vertebral body, which will in turn alleviate pain and improve posture.
Who has made this decision?

Your suitability for the treatment will have been made by the consultant radiologist at the hospital. The purpose of the procedure and potential complications will have been explained and will be explained again when you attend for treatment.

What are the risks associated with vertebroplasties?

Generally it is a very safe procedure. Potential complications are uncommon and include:

• Bleeding or haematoma (a bruise under the skin) around the injection site, which should settle down by itself
• Infection. Contact your GP if you experience any redness or tenderness at the injection site
• Allergic reaction to the drugs or cement used at the time of the procedure
• Leakage of the cement which might compress the spinal cord or block a blood vessel to the lungs
• Rib fractures
• X-rays are used in this procedure but with modern equipment the risk from the x-rays is low (Public Health England 2014).

The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

What happens before the procedure?

Prior to the procedure you may have already:

• Had an assessment for your suitability for the treatment by the consultant radiologist
• Attended for an MRI
• If necessary, you may have been asked to attend the pre assessment clinic, to perform standard checks, including blood tests, ECG and discussed existing medication.

On the day of the procedure:

• Depending on the time of the procedure, you may either have a light breakfast or you will be sent instructions by letter, of what times you can eat and drink beforehand. Please take a sip of water with your regular medication only.
• You will arrive at Radiology Day Case (Gate 19), where a suitable day case bed will be allocated for you. However if you use warfarin routinely, you may need to stay in hospital overnight.
• You will be asked to change into a hospital gown.
• A nurse or doctor will put a cannula into a vein in your arm. This is so that we can give sedation, antibiotics, fluids and painkillers you might need during the procedure.
• The consultant radiologist will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to proceed with the procedure you will be asked to sign a consent form.  
• The procedure will be carried out under local anaesthetic, which numbs the area to be treated, together with some sedation. 
• Once brought to the x-ray room, you will have to lie face down on the x-ray table. There will be a small team of nurses, doctors and radiographers throughout.
• A hollow needle is introduced into the vertebral body through the skin of the back. The radiologist will position the needle into the correct place by use of x-ray guidance. Once the tip is precisely positioned within the affected vertebral body the liquid cement is injected. The cement hardens inside the fractured vertebral body over the next few minutes.
• A CT scan is then performed in the same room, to confirm the position of the cement.
• The procedure will take approximately 30 minutes for each fracture that needs to be treated.

What happens after the procedure?

• You will be taken back to a recovery area initially, so that nursing staff may monitor you closely as the sedation wears off.  After the effects of the sedation have worn off, you will rest for a few hours before being allowed home.
• You are likely to have some discomfort in the area of the wounds, please inform the staff if you require painkillers.
• If you are allowed home on the same day, you will need someone to stay with you at least overnight and until the effects of the sedation have worn off.

What happens next? 

• Please continue your regular painkiller medication for three days after the procedure. If the pain is eased at this point, you may then wean off your painkillers under doctor supervision.
• You will be invited for a follow up appointment with the consultant radiologist 4 weeks after the procedure.
• If you experience any symptoms you are concerned about, please contact the imaging department directly or alternatively contact your GP or the emergency department.

Finally we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them.

The telephone number for the Imaging department can be found on the appointment letter.

Reference:

• National Institute for Health and Clinical Excellence - Percutaneous Vertebroplasty
• Radiologyinfo.org - Vertebroplasty & Kyphoplasty
• Public Health England - Exposure to ionising radiation from medical imaging: safety advice - GOV.UK

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.