Surgical Procedure Commonly Performed in Elderly Patients with Spinal Fractures
This is a surgical procedure applied to prevent further collapse of the vertebral body and relieve pain, typically seen in elderly patients with spinal fractures. While the procedure is mostly performed under sedation and local anesthesia, general anesthesia is safer for multiple-level vertebroplasty and kyphoplasty procedures.
How Is Vertebroplasty Performed?
The vertebroplasty procedure is conducted under fluoroscopic guidance. Once the fractured vertebra is identified with the fluoroscopy device, local anesthesia is administered to the right and left sides of the targeted vertebra up to the bone if the patient is under sedation. A sharp, hollow cannula approximately 2 mm in diameter is then advanced through the pedicle structure of the vertebra into the vertebral body using a two-planar imaging approach. Bone cement, known as cement, is then injected through this cannula.
How Is Kyphoplasty Performed?
Similar to the vertebroplasty procedure, a cannula is placed into the vertebral body. A balloon is then advanced through this cannula and inflated upon reaching the vertebral body. The purpose here is to elevate the collapsed vertebral body. Cement is then injected into the vertebral body.
What Are the Risks of Vertebroplasty and Kyphoplasty?
There is a possibility of cement leakage into the surrounding tissues or spinal canal during the procedure. While minimal cement leakage may not cause issues, severe leakage poses a small risk of paralysis. To minimize this risk, the surgeon must ensure accurate placement. Cement should not be injected when it is too fluid, and frequent imaging should be performed. When surgical techniques are properly adhered to, the rate of complications is quite low. Cement leakage to vital organs such as the lungs can sometimes occur, but related complications are very rare when performed by experienced hands. Another potential complication is infection, but it is very rare, occurring at a rate of approximately one in a thousand.