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Learn about interventional radiology
Massachusetts General Hospital Imaging provides vertebroplasty, a minimally invasive, image-guided treatment for back pain caused by vertebral fractures, on the Mass General main campus in Boston. Performed by specially trained radiologists using real-time image guidance, interventional-radiology procedures such as vertebroplasty require smaller incisions, have fewer risks of complication, and take less recovery time than traditional surgery.
Vertebroplasty in depth
What is a vertebral fracture?
A vertebral (spine) fracture occurs when the usual rectangular shape of the bone becomes compressed and distorted, causing pain and in some cases, disability.
These compression fractures, which may involve the collapse of one or more vertebrae in the spine, are a common symptom and result of osteoporosis. They are also sometimes caused by trauma or cancer.
Vertebroplasty is the injection of cement-like material (bone mineral substitute) into a collapsing vertebral body. The procedure is performed to reinforce the fractured bone, alleviate chronic back pain, and prevent further vertebral collapse. The cement-like material stabilizes and strengthens the crushed bone.
Vertebroplasty is an example of an interventional radiology procedure. In such procedures, specially trained radiologists use real-time imaging technology to guide them as they perform a treatment that provides pain relief or addresses the cause of a disease. Interventional procedures are "minimally invasive," which means that they use smaller incisions, have fewer risks of complication, and require less recovery time than traditional surgery. In many cases, our doctors helped to pioneer the interventional treatments that we offer
The interventional radiologists who perform procedures at Mass General Imaging are specialists in the area of the body and the condition under treatment, as well as the procedure itself. In addition to the training that all radiologists receive, these specialists have additional education, plus extensive real-world experience. In many cases, our doctors helped to pioneer many of the interventional treatments that we offer.
Our team of interventional radiologists and nurse practitioners coordinates a patient's complete care—from imaging evaluation to post-procedure followup—maintaining a high level of communication with the patient throughout the process. In addition, Mass General Imaging works in close coordination with experts from across Mass General when necessary.
When should I consider vertebroplasty?
Candidates for vertebroplasty include men and women who have chronic back pain (at least six weeks) and debilitation due to vertebral body fracture or disc herniation. Patients often have limited mobility and cannot perform routine daily activities, such as bathing, dressing and walking. Vertebroplasty is usually performed after conservative treatments (bed rest, back brace, oral pain medications) have failed. Most patients are elderly (average age 70 years), but younger patients with osteoporosis, due to metabolic disorders or long-term steroid treatment, may also benefit from vertebroplasty. Some patients with vertebral destruction from malignant tumors are also candidates.
Not all patients with vertebral fracture are appropriate candidates for vertebroplasty. Careful screening is critical to ensure that symptoms are due to the vertebral fracture, rather than another problem. It is not enough that patients have a vertebral fracture, since a healed fracture should not cause pain. Thus, it is necessary to exclude other potential explanations for back pain, such as disc herniation, severe arthritis, and compression of the spinal cord or nerve roots.
What should I expect BEFORE vertebroplasty?
All patients must be evaluated by one of our staff prior to vertebroplasty. Sometimes a telephone interview is sufficient, but usually you must be seen in person. The evaluation includes a directed history and physical examination and blood tests. Often, patients can point to a single painful spot. If the location of pain matches the level of fracture seen on standard radiographs (x-rays), then there is a good chance that vertebroplasty will be successful.
At our initial evaluation, you should bring any imaging studies that were not performed at Massachusetts General Hospital. It is essential that you have recent plain radiographs and MRI. If MRI cannot be performed (due to a cardiac pacemaker, for example), CT scan is necessary. Some patients may need examination under fluoroscopy or bone scan.
What should I expect DURING vertebroplasty?
Vertebroplasty is a non-surgical procedure that is performed using state-of-the-art imaging (fluoroscopic) guidance. The procedure is usually performed in the morning. You must be able to lie face down for one to two hours. Our team of professionals will make you as comfortable as possible. An intravenous line will be placed in your arm to decrease anxiety and control pain. Intravenous antibiotics are also administered to prevent infection.
After using a local anesthetic to numb the skin and muscle, a needle is positioned in the collapsed vertebral body. We inject a radiology contrast agent to confirm proper needle placement, followed by the cement-like material. The longest part of the procedure is setting up the equipment and positioning the needle in the collapsed vertebral body. The actual injection of cement takes only 10 minutes. Medical-grade cement is similar to epoxy or glue. It is injected in a liquid form that quickly hardens over 10 to 20 minutes. We usually obtain a CT scan after vertebroplasty to evaluate the distribution of cement.
What should I expect AFTER vertebroplasty?
Patients usually recover after a few hours and can go home with an adult if the trip is short. Otherwise, you should plan on staying overnight in a local hotel. Hospitalization is not required unless you are extremely frail or require additional monitoring after the procedure.
Patients may experience dull aching at the needle puncture site during the first 24 hours following the procedure. An ice-pack can help with this discomfort. Tylenol or non-steroidal anti-inflammatory medication is usually sufficient. Narcotic pain medications should be minimized. You should call us if you develop severe or increasing chest or back pain, fever, or neurological symptoms.
We call patients at home approximately 48 hours following vertebroplasty, and again at seven days. Otherwise, patients receive follow-up care from their referring or primary care physicians. To hasten recovery and regain satisfactory levels of activity, you may benefit from physical therapy or short-term back bracing.
Osteoporosis should be treated if medical therapy has not already been instituted.
Risks associated with vertebroplasty
Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem, unless the leakage moves into a potentially dangerous location such as the spinal canal.
Other possible complications include infection, bleeding, increased back pain and neurological symptoms such as numbness or tingling. Paralysis is extremely rare. Sometimes the procedure causes another fracture in the spine or ribs.
In advance of the annual meeting of the North American Spine Society this week in Boston, neurointerventional radiologist and department vice chair Joshua A. Hirsch, MD talks about the landmark VAPOUR trial on vertebroplasty.
An active octogenarian, John Higgins walked up to four miles a day to stay fit. But one night last winter, he slipped on a sheet of ice. “I went down and hit my hip,” he says. He remembers the agony he felt on both sides and across the middle of his back. “I couldn’t take a step without excruciating pain. There was nothing I could do.”
The SNIS is a national organization of physicians who have special expertise in treating such conditions as stroke, aneurysms, carotid stenosis and spinal abnormalities through minimally invasive procedures.
Recent studies have challenged the effectiveness of a popular kind of back surgery, yet many patients, and their doctors, say vertebroplasty works
Two new studies cast serious doubt on a widely used and expensive treatment for painful fractures in the spine.
Department of Radiology Chairman Emeritus James H. Thrall, MD, explains how the ability to see deep inside the body has driven the development of minimally invasive methods of treatment—a trend in which Mass General Imaging has played a key role.
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