• Reference Number: HEY1244/2021
• Departments: Radiology
• Last Updated: 30 June 2021

Introduction

This leaflet has been produced to give you general information about your vertebroplasty procedure.   Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a vertebropasty?

Vertebroplasty is the injection of bone cement into the vertebral body in order to relieve pain and / or stabilise the fractured vertebra.

This procedure is done through a tiny incision on the skin- one or two for each bone that is treated.  A needle is placed into the vertebral body using X-ray guidance and the procedure is carried out through the needle. This can avoid a large scar and greater physical trauma of open surgery.

The first vertebroplasties were carried out in France in 1984 for the treatment of compression fractures caused by bone tumours. Later it was also used to treat fractures caused by osteoporosis. Since 1997 percutaneous vertebroplasty has become a widely used procedure. It is carried out by a specialist doctor called an Interventional Radiologist.

Vertebroplasty stabilises fractured or collapsed vertebrae, to reduce or stop the pain caused by the bone rubbing against the periosteum (the thin layer of connective tissue that covers the outer surface of the bone). The painful pressure on the vertebral joints caused by a collapsed vertebra is also reduced considerably. Most patients experience immediate pain relief after the procedure.

Why do I need a vertebroplasty?

Vertebroplasty is considered:

• For a painful osteoporotic fracture when the pain has not been adequately controlled by optimal pain management (pain relief medication etc.)
• For a painful benign vertebral tumour such as a haemangioma or giant cell tumour
• For a painful vertebra due to a malignant tumour

These are referred to as the “indications” for the procedure, or reasons why it might be carried out.

The main aim of the procedure is to control pain. It may also prevent further collapse of the vertebra.

Vertebroplasty is not carried out if:

• The patient is at more risk of bleeding than normal (due to a medical condition or certain medications)
• There is infection in the blood or at the site of the procedure
• The patient already has decreased use of limb(s), bowel or bladder
• Heart, breathing or other problems mean that general anaesthetic or sedation are not safe
• The fracture is not causing symptoms, or is improving with pain relieving medications etc.

These are referred to as “contraindications” – the reasons why the procedure would not be carried out.

Can there be any complications or risks?

The main potential adverse effects (complications) of the procedure are extravasation of cement (leaking of cement into blood vessels) and compression of the spinal cord due to leaking of cement backwards out of the body of the vertebra and into the space around the spinal cord.

Pulmonary embolism is when cement leaks into veins and then travels in veins to the lung. It is rare. Nerve damage and infection are also rare.

Overall complication rate for osteoporosis or benign tumours is 1 – 3 %, and for malignant tumours 1 – 10%.

Patients who have had one vertebral collapse fracture have a higher chance than other people of having another fracture in the future. It is important to treat the cause of the fracture e.g. osteoporosis. Prophylactic treatment of vertebrae with vertebroplasty above and below the fracture (being treated with vertebroplasty) is sometimes considered to reduce this risk.

How do I prepare for the vertebroplasty?

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

You will have a pre-assessment carried out by a nurse either in person or by phone.  You will need to give the nurse details of any medications you are taking.

If you take any medication to thin your blood, you will be advised about when you need to stop this, to reduce the possibility of excessive bleeding.

For 6 hours prior to your appointment you will be asked to have no food, and only drink water (not fizzy).

For 2 hours before your appointment you will be asked to have no food or drink.

You will be advised at pre-assessment about what regular medication you should take and if you are a diabetic who takes insulin you will be advised accordingly.

What will happen?

If you are a hospital inpatient, you will be taken to the Radiology Department

Day patients will be asked to attend the Radiology Day Unit on the second floor at Hull Royal Infirmary.

On arrival you will be greeted by a nurse who will carry out some checks and ask you to change into a hospital gown.

You will meet the Interventional Radiologist who is a doctor with specialist training to perform this procedure.  The doctor will discuss the procedure and ask you to sign a consent form.

You will also meet the anaesthetist who is responsible for making sure that you are comfortable during the procedure, although it is unlikely that you will have a full anaesthetic. You will have a combination of drugs that make you feel very sleepy, minimise any pain, and may cause you to forget what has happened during the procedure.

It may be necessary for you to have a full general anaesthetic if you need to have several fractures treated in one appointment, or for other medical reasons.

You will be taken into the Radiology Theatre where you will be assisted to lie on your tummy with your arms above your head. If this is likely to be a problem because you have breathing difficulties or shoulder problems, for example, you will need to inform the staff beforehand.

The anaesthetist will give you the necessary drugs, and your back will be cleaned with antiseptic and covered with a sterile towel.  The radiologist will check the position of your fracture using X-rays, and give local anaesthetic into your skin. The Radiologist will insert special needles into the fracture(s) and inject the cement, using the X-ray machine for guidance.  When the cement is in position, the needles will be removed and dressings will be applied to the puncture sites.

What happens afterwards?

You will be helped back onto a trolley where you will rest in the Radiology Recovery Area until you are fully awake.

There is not enough space to accommodate your relatives, but please let the department know if you have any special needs.

You will be offered a drink and something light to eat, but please bring something with you if you have any special dietary requirements.

You will be advised when you can get up and move around.

If you feel well and all your observations are satisfactory, you will be able to go home within a couple of hours.  You will need to arrange for someone to take you home by car or taxi.  It is not advised to travel home on public transport.

What do I need to do after I go home?

You will have been assessed prior to your discharge from the Radiology Day Unit to ensure that you have sufficiently recovered from the sedative medication that you have been given and that any pain you have is of an acceptable level.  You should have a capable adult with you overnight for your first night at home.

Dressings:  You have steri-strips over your puncture hole(s), covered by a dressing.  It is best to keep this dressing dry if possible.  If it gets wet or dirty it can be replaced with a similar clean dressing at home. It may be removed after 48 hours.

Activity:  You can begin to resume activity today, once you feel fully recovered from your sedative medication.

It is advised to take things gently and gradually build back up to your normal activity over the course of 2-3 days.  Please discuss with your doctor when you may be able to return to work.

Avoid stooping postures and prolonged standing.

Pain relief medication:  Please continue to take your pain relief medication as required.  You may feel soreness around the treatment areas for the first 24 hours or so, but this should gradually wear off and you may be able to reduce your pain relief medication. Please seek advice from your doctor for further pain management.

Problems that may occur

Patients who have a diagnosis of osteopenia or osteoporosis may suffer fractures at the levels adjacent to the treated vertebra. If you have new onset of pain similar to what you had with your previous fracture in the days following the procedure, please contact your doctor as this could be due to a new fracture.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Radiology Department (01482) 675667. Outside office hours please contact your doctor or your Referring Consultant.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.