What is the Vertebroplasty Set?

Osteoporosis is one of the systemic skeletal diseases, that each year causes a huge economic and social cost to the medical system of the country and the people. The purpose of this article is to introduce the vertebroplasty method in the treatment of osteoporosis of the vertebral column and the set of vertebroplasty tools. For this purpose, we will first explain the fracture of the vertebral column, the factors that cause it, and the treatment methods, specially the vertebroplasty method, specifically.

Fracture of the vertebral

According to the American Center for Disability and Rehabilitation Research, more than 14,000 Americans suffer from low back disorders every year. Many of these injuries never require surgery, but severe cases may require surgery. Spinal compression fractures can occur due to car accidents, falls from a height, sports accidents, violent action (such as gunshot wounds), or osteoporosis, and can cause severe pain. Research has shown that 3% of all spinal fractures are pathological, 14% are related to trauma, and 83% are caused by osteoporosis.

The most common causes of osteoporosis are related to age (primary) or due to the use of steroids (secondary). The prevalence of osteoporosis in women aged 50 or older has been reported to be 26% higher than in other people. The studies conducted in Iran showed that the maximum bone density in the lumbar spine in men and women is between the ages of 20 and 29 years, and the decrease in density starts at the age of 40.

It is interesting to know that vertebral fractures are the most common osteoporotic fractures. But almost two-thirds of them go undiagnosed and untreated!

The most important parts affected by fracture are the thoracic and lumbar regions.

Spinal fractures cause moderate to severe pain that worsens with movement. If the spinal cord is also involved, the patient may experience bowel/bladder dysfunction with numbness, tingling, or weakness in the limbs. If the fracture is caused by trauma, the patient may suffer brain damage and lose consciousness.

Treatment of vertebral fractures

In general, two types of treatment are used for spinal fractures. The brace is used in mild fractures, and surgical treatment is used in severe fractures.

Most mild fractures are treated with immobilization in a brace for up to 12 weeks. The brace helps to reduce pain and prevent deformity. Brace or Orthosis is the general name for devices that are placed and worn around the limb to control the movement of the limb or affect its shape.

You can see an example of a spine brace in the photo below:

In severe cases or with pain causing problems for the patient, as well as in cases where quick recovery is needed, the treatment is surgery.

Two types of minimally invasive surgical procedures common in vertebral column fractures are vertebroplasty and kyphoplasty.

What is the Vertebroplasty?

Spine surgeons typically use standard open surgery to treat various vertebral fractures. In open surgery, it is necessary to cut the skin and lower layers up to the injured vertebrae and their side vertebrae so that the surgeon has the space required for a correct and complete operation. In cases where vertebral fractures have not severely displaced and do not damage the spinal cord, and are the main cause of osteoporosis, many surgeons in this field prefer to use the two minimally invasive methods of kyphoplasty and vertebroplasty.

Vertebroplasty is usually used in cases where we don’t have compression and change in the shape of the vertebra. Vertebroplasty is a better option for the patient due to the short operation time, no opening of the viscera and lower cost. In addition, elderly people with fractures may not be physically able to tolerate open surgeries.

Vertebroplasty gives surgeons a way to repair and fix a broken bone without the complications associated with open surgery. Unlike open surgery, vertebroplasty is a minimally invasive procedure. It requires small holes in the skin and small tools. This reduces the chance of bleeding, infection, and damage to muscles and tissues.

History of vertebroplasty

Vertebroplasty was first introduced by Gilbert et al. in 1987 as a non-invasive treatment for hemangioma of vertebrae and spine. Hemangiomas are non-cancerous tumors located in blood vessels. Since then, vertebroplasty has been used to treat other bone diseases such as osteoporosis, spinal metastasis, and traumatic vertebral fractures. In Iran, this procedure was performed for the first time in 1381 in one of the hospitals in Semnan province.

The purpose of vertebroplasty is to relieve pain and stabilize compression fractures of the vertebrae.

In the United States, osteoporosis causes more than 1,500,000 fractures each year, and as the rate of vertebral compression fractures increases, researchers are trying to find and optimize safe methods. Vertebroplasty not only stabilizes the fracture of the vertebra but also significantly reduces the pain of the patients.

Vertebroplasty is a minimally invasive procedure in which medical-grade bone cement is injected into the vertebral body through a needle (Trocar). The cement hardens quickly, stabilizing the fracture and strengthening the weakened bone. Most patients experience pain relief after cement injection.

Reports show that after vertebroplasty, about 75% of patients recover completely.

How is vertebroplasty performed?

To perform vertebroplasty, the patient is under local or general anesthesia (according to the doctor’s diagnosis). During the operation, the patient lies on his / her stomach on the operating bed. The vertebral column is photographed through high-quality X-rays using the fluoroscope. Then a long needle called trocar (Bone Needle) is carefully inserted into the broken body of the vertebra. It is usually done for repair with two needles (trocar) and from both sides of the vertebra body.

Once the needle is in the right position, the cement is mixed and slowly injected. When the open spaces in the body of the vertebrae are filled, the needle is removed. The procedure usually takes less than an hour.

Some patients have more than one vertebral fracture, and the other vertebrae are also treated.

After the operation, sometimes an overnight stay in the hospital is necessary for the patients, but many patients are discharged on the same day after a few hours of being cared for in the hospital.

Most patients experience significant pain relief in the first to second day after vertebroplasty.

What is the difference between kyphoplasty and vertebroplasty?

Kyphoplasty and vertebroplasty have similarities and differences from each other. Both of these procedures are non-invasive surgeries and correct fractures and osteoporosis of the spine. However, they have fundamental differences.

The purpose of the vertebroplasty method is fixation, reduce pain and return the strength of the vertebra to the proper state.

But in the kyphoplasty method, in addition to reducing the pain and stability in the vertebra, the compression of the injured vertebra is also repaired and the vertebra is restored to its original shape. This operation is done by balloon to fix the vertebral body and return the height of the vertebra.

In the case of vertebroplasty, the needle is inserted through the holes created on both sides of the spine. Then the cement material is directly transferred to the cracked part (without a balloon).

The following video shows the procedure of performing both kyphoplasty and vertebroplasty and compares them.

Advantages and disadvantages of vertebroplasty

Advantages:

• Return of the strength and power of the vertebrae of the spine
• No need for long-term hospitalization
• Returning to daily activities in the short term
• Less risk than open surgery
• No need for general anesthesia in most cases
• Pain relief after 72 hours

Disadvantages:

• The possibility of leakage of the cement material to the surrounding tissues (This is more common in vertebroplasty than in kyphoplasty).
• Formation of blood clots in deep veins
• Complications caused by anesthetics
• Pain
• Bleeding
• Fever

Vertebroplasty postoperative care

• The patient will be under intensive care for about 1 to 2 hours.
• The patient experiences pain for about 72 hours. Painkillers or cold water compresses can be used to relieve pain.
• To prevent infection, the patient should avoid opening or soaking the dressing for 48 hours.
• The patient may need to continue wearing a brace, but it is usually unnecessary.
• The patient should gradually resume his / her daily activities.
• The patient should refrain from heavy activities and sports such as lifting heavy objects for 6 weeks after the operation.

Medication considerations:

• Pain medications – are usually given to the patients for a few days after the operation to reduce pain.
• Osteoporosis medications – to prevent osteoporosis from progressing and reduce the risk of future fractures.

Vertebroplasty Set  

For vertebroplasty and kyphoplasty, X-ray equipment, a needle or a hollow tube called a trocar, a syringe for cement injection and orthopedic cement are used.

Portable x-ray devices or fluoroscope (suitable and preferred option) are necessary to show the location of the lesion and the correct using of tools during the operation of the patient.

For this purpose, radiographic film cassettes are placed under and on the side of the patient during the operation and at appropriate times, and appropriate images are recorded by the radiology technician by moving the arm of the device and adjusting it on the spot. When using a fluoroscope, the work will be much easier, more accurate and less complicated.

In this method, after the initial setting of the device and placing the C-shaped arm in the right place, the image will be visible on the monitor at any time needed by moving the arm.

Orthopedic cement contains a material called Poly(methyl methacrylate) (PMMA). The physical appearance after combining the two parts is similar to toothpaste, which hardens soon after being placed in the body. In this method, other equipment such as an intravenous catheter (IV), monitoring device, and devices that control your heart rate and blood pressure may be used to ensure the patient’s condition during the operation.

Vertebroplasty set of Asia Jarah Pishro (AJP)

Asia Jarah Pishro Company offers the AJP brand vertebroplasty set to perform various steps including creating a path and entering the body of the vertebrae and delivering bone cement to the spine during said surgery.

The AJP vertebroplasty set includes a trocar with a special tip (Pen Point) for ease of passing through the skin. And the path of movement and a cement injection syringe with a one-way function to prevent mistakes during the injection.

Vertebroplasty set of Asia Jarah Pishro is provided as single use and with a gray colored trocar handle, which has the necessary strength and color separation compared to the kyphoplasty tool.

Warnings:

• Sterilized by ethylene oxide
• Surgery must be performed by a specialist surgeon.
• Imaging equipment such as fluoroscopy should be used during surgery.