1. What is it?

The sturdiness of the vertebrae can be impaired due to a number of causes. One is decalcification of the bones (osteoporosis). This is a condition in which more bone degrades than is made up by the body over the same period. Tumours in the vertebrae also can lead to weakness. If a vertebra becomes fragile, it can collapse due to the high load exercised on it. In medical terms this is called a compression fracture. The spine consists of 34 vertebrae linked to each other by means of intervertebral discs. From top to bottom we count 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae and 5 coccygeal vertebrae (of the coccyx).

The spine seen from the side

Illustration: The spine seen from the side

  1. cervical vertebrae
  2. thoracic vertebrae
  3. umbar vertebrae
  4. sacral and coccygeal vertebrae

This tower of vertebrae forms a sturdy yet flexible central "rod" for the body. In addition, the vertebrae surround the vertebral canal, which houses the spinal cord. The intervertebral discs act as a sort of "shock absorber", buffering the pressure forces that develop in the spine when the person stands, walks, jumps and so on.

The difference between a healthy vertebra and a collapsed vertebra is clearly shown in the illustration below. A compression fracture can have the following consequences: severe back pain, pinched nerves, deficiency or dysfunction symptoms and pain in the limbs.

The spine seen from the side in an X-ray image

Illustration: The spine seen from the side in an X-ray image.

The difference between a collapsed vertebra and a healthy vertebra is clearly shown.

  1. collapsed vertebra
  2. healthy vertebra

2. 2. What can be done about a collapsed vertebra?

When a vertebra has just recently collapsed and is painful, a plaster or plastic support corset can be very helpful against the pain and promote the healing process. Frequently the patient is also given painkillers. Luckily most collapsed vertebrae can be successfully treated without surgery, certainly in the case of collapse due to osteoporosis. The choice of treatment depends directly on the cause and the severity of the collapse.

If despite the standard corset and painkiller treatment significant symptoms persist, a new technique makes it possible to obtain good pain relief for the patient in many cases. The official name for this treatment is "percutaneous vertebroplasty". The advantage of this technique is that if the treatment works, patients can resume their normal activities after just a few days.

3. What is percutaneous vertebroplasty?

Literally, it means "strengthening the vertebral body by accessing it via the skin". Actually this is a good description of what the doctor seeks to accomplish with the treatment. He or she introduces one or two needles through the skin of the patient's back and into the collapsed vertebra. A small amount of "cement" is introduced. The cement restores the sturdiness of the collapsed vertebra. During the examination, X-rays are used to take a look inside the body.

The first percutaneous vertebroplasty was carried out in France in 1984 by Dr Deramond. Due to the huge success of this procedure in other countries, including the United States and France, it has become better known both with doctors and with patients.

4. Percutaneous vertebroplasty: the treatment

4.1. What happens before the vertebroplasty?

The specialist and the patient together will decide if vertebroplasty is the right treatment. Prior to the procedure the patient will spend two days (one night) in hospital. A number of preliminary examinations are necessary before the actual treatment can be performed. With the help of these examinations the specialist can determine the patient's overall medical condition. In addition to a preliminary outpatient examination, others will be carried out on the first day of admission. However, it is possible that all necessary examinations have already been carried out in an outpatient setting.

4.2. How does vertebroplasty work?

Percutaneous vertebroplasty is performed in the Surgery Department. The patient is made to lie on his or her front on the treatment table. He/she will remain in this position during the entire treatment (approximately 1 hour). First, the nurse will disinfect part of the skin on the patient's back. The surgeon anaesthetises (numbs) the skin. Once the anaesthesia is working, the surgeon will start introducing one or two vertebroplasty needle(s) into the affected vertebra. This is done with the help of X-ray images. Once the vertebroplasty needles are positioned at the correct location, the special cement solution is introduced. The vertebroplasty needles are removed as soon as enough cement solution has been injected. When the cement has reached a certain degree of hardness, the patient may return to his or her bed. Now, the patient lies flat on his or her back. Before the patient returns to his or her room, an X-ray is taken in order to obtain a detailed picture of the how the cement has distributed within the vertebra.

Another possibility in addition to vertebroplasty is kyphoplasty. It involves approximately the same technique, but the needles are used, in the first instance, to insert a small balloon to "inflate", as it were, the collapsed vertebra before injecting the cement. The X-ray images are spectacular, but the advantage to the patient is not always obvious. In fact the additional cost is of approximately € 5,000, and is not reimbursed by Belgian mandatory health insurance. Patients thus only rarely choose this alternative.

Position of the needles in the vertebra

Illustration 1: Position of the needles in the vertebra.

  1. Vertebroplasty needle
  2. Spinous processes on the posterior, or back, side
  3. The vertebral body.

Sideways X-ray image of a treated vertebra

Illustration 2: Sideways X-ray image of a treated vertebra.

  1. Cement distribution