Three new techniques have recently been developed to treat traumatic and pathological (osteoporosis, cancer metastases, etc.) fractures of the spine. These are vertebroplasty, kyphoplasty and stentoplasty. ¬¬These methods are applied closed, through small incisions in the skin (percutaneous), and each involves the placement of cement into the body of the spine.
– Vertebroplasty: It is the process of placing bone cement into the broken bone
– Kyphoplasty: It is the process of first removing the collapsed broken pieces of the bone with the help of a balloon, and filling this area with bone cement after the balloon is removed.
1. Vertebroplasty Method
Percutaneous Vertebroplasty is a new and minimally surgical technique that can be an alternative in the treatment of osteoporotic fractures when traditional treatments are inadequate. Vertebroplasty can strengthen the spine in patients with spinal fractures due to osteoporosis or in patients with spinal tumors or spinal trauma.
After a spinal compression fracture is diagnosed via MRI or CT, the patient is placed face down and sedated with a light anesthesia. Guided by an imaging method called fluoroscopy, the doctor enters the affected vertebra through a small skin incision using special needles and injects a cement-like substance (polymethyl methacrylate) into the vertebra.
The injection itself takes only 10 minutes, while the entire process takes about an hour. The cement mixture hardens in about half an hour, and the patient can go home the same night or the next day after waiting for a short time in the ward to recover. Usually, patients are given painkillers to relieve the pain in the first few days.
If the wound is very dirty and will be left open, nerve suturing may not be performed during the first operation. If there is a nerve defect (deficiency), the continuity of the nerve is ensured by placing a nerve graft (part) taken from the leg.
In what cases is Vertebroplasty applied?
Since patients with osteoporosis are often older and may have other diseases that pose risks for surgery, vertebroplasty, which is a less invasive procedure, may be preferred to open surgery. Vertebroplasty does not correct bone loss due to osteoporosis, but it provides detection of fractures.
The spine is the region where cancers most frequently spread (metastasize) to other regions. Therefore, spinal metastases in these patients may cause pain and fractures. Vertebroplasty provides spinal stabilization in these patients and improves quality of life by reducing pain and increasing the ability to work.
Percutaneous Vertebroplasty strengthens and stabilizes the broken spine and relieves pain in osteoporotic spine fractures. However, osteoporosis is a systemic disease and requires systemic treatment. In patients with any vertebral fracture, the likelihood of another fracture in the vertebrae immediately adjacent to the fractured vertebra is five times higher than normal. Therefore, medical treatment that will reduce the severity of osteoporosis should be started in these patients.
Although complications occur in less than 1%, percutaneous vertebroplasty can cause infection, bleeding, or embolism (blockage in the vessels) due to the cement mixture entering the bloodstream and passing through the heart and lungs.
1. Kyphoplasty Method
Kyphoplasty is a new method that is used in the treatment of osteoporotic spine fractures, which may occur due to osteoporosis, especially in post-menopausal women, and requires minimal surgical intervention. As in vertebroplasty, the main purpose of this procedure is to strengthen the spine. However, an advantage of kyphoplasty is that it can correct the vertebra that has collapsed due to the fracture and thus correct the hump that develops due to the fracture.
In general, spinal fractures due to osteoporosis cause the front parts of the vertebrae to collapse and fuse together to form a wedge. This causes pain, shortening in height and a hunched appearance.
Kyphoplasty is a two-step procedure. First, a special balloon is placed inside the broken and crushed vertebra, and the balloon is inflated to elevate the walls of the broken vertebra and allow the vertebra to take a more normal shape. Subsequently, the space created by the balloon is filled with a cement-like substance (bone cement, polymethylmethacrylate) to ensure that the normal (corrected) shape is permanent. The alignment and shape of the spine can be corrected by giving the vertebrae more normal shapes.
Kifoplasti sırttaki küçük bir kesiden yapılır. Hastanede, durumun ciddiyetine göre lokal ya da genel anestezi altında yapılır. Tüm işlem düzeltilen her bir omur için yaklaşık bir saat sürer. Hasta ameliyat günü taburcu edilir ya da o geceyi hastanede geçirmesi istenebilir. Ameliyatı takip eden iki gün içerisinde ağrının dindiği fark edilebilir.
