On the operating table, the patient is in a prone position. ECG, blood pressure cuffs, and pulse oximetry are used to monitor vital signs. After sterilizing the skin above the target vertebra, topical anesthetic-typically 2% lidocaine is given.
The entrance point on the back is identified under continuous fluoroscopy or CT guidance. A tiny skin incision is made, and a needle (usually 14-gauge) is carefully advanced to the center of the spine by inserting it transpedicularly through the pedicle into the vertebral body.
Cannulas are used to gradually dilate the needle tract until a functional cannula reaches the desired location inside the vertebral body. This makes it possible for devices to pass through safely without causing harm to nearby tissues.
In order to monitor distribution and avoid leakage, a polymethylmethacrylate (PMMA) bone cement is produced and injected into the vertebral body under live imaging. The cracked or weaker bone is stabilized by the cement's rapid hardening.
To restore vertebral height and create a cavity, a balloon tamp is placed through the working cannula and inflated. To stabilize the bone, PMMA cement is injected into the cavity after the balloon has been deflated and removed.
The cannula and needle are gently withdrawn after the cement injection is finished. After applying pressure to the tiny skin puncture, a sterile bandage is applied. Usually, sutures are not required.
After the procedure, patients are monitored for a few hours to track their vital signs and neurological condition. Analgesics are used to treat pain, and patients can typically return home the same day or following a brief hospital stay.
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Patients with severe pain from pathological compression fractures or vertebral body metastases are the main candidates for vertebroplasty and kyphoplasty. To guarantee targeted treatment, the pain should be clinically and radiologically correlated with the affected vertebra.
These operations assist in stabilizing the spine and restore vertebral height in patients with vertebral compression fractures caused by metastases or decreased bone structure that causes instability.
For patients who need mechanical stabilization and pain relief but are not candidates for open surgery because of their general health, comorbidities, or severe disease, these minimally invasive techniques are perfect.
Patients without severe spinal cord compression or neurological deficits that would necessitate more involved decompressive surgery are the best candidates for vertebroplasty and kyphoplasty.
Improving quality of life is a major objective because most candidates suffer pain that is severe enough to interfere with daily functioning or necessitate the use of substantial medications.
For individuals with excruciating spinal metastases, vertebroplasty and kyphoplasty offer quick and efficient pain alleviation. They lessen mechanical discomfort brought on by micromovements and fractures by stabilizing the weaker vertebrae.
In order to stop additional collapse and spinal deformity, these treatments reinforce and stabilize the vertebral bodies damaged by pathological fractures or metastatic lesions.
Improved mobility, which enables patients to resume daily activities and improves overall quality of life, is facilitated by pain relief and spinal support.
Compared to open surgery, these techniques are less intrusive and have lower rates of complications. They are appropriate for elderly or frail individuals since they can be carried out under local anesthetic with brief hospital stays.
In contrast to vertebroplasty, kyphoplasty re-expands the compressed vertebra to restore vertebral height and lessen kyphosis, a spinal deformity that can improve posture and lessen back discomfort.
Patients who get substantial pain relief frequently need lesser dosages of opioids and other analgesics, which lessens the negative effects of these drugs.
By reducing discomfort and enhancing functional status without requiring significant surgery, vertebral augmentation provides a palliative benefit for individuals with advanced cancer.
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