Techniek van vertebroplastie Voorbeeld van wervelbreuk Techniek van vertebroplastie

Vertebroplasty is a surgical technique whereby a vertebral fracture can be repaired in a minimally invasive manner by injecting a special type of “cement”.

  • Figure 1: Vertebroplasty technique
  • Figure 2: Example of vertebral fracture
  • Figure 3: Difference between osteoporosis and healthy bone tissue
  • Figure 4: Vertebroplasty technique

Vertebrae can be damaged in different ways. Obviously because of accidents: falling from a height, sport injuries in cyclists or horse riders, etc. Vertebrae can also collapse due to bone decalcification (osteoporosis).

Severe fractures that are “unstable” and can lead to, for example, paralysis must naturally be treated surgically. However, in many cases this is not necessary and less invasive treatment involving bed rest and a corset suffices. Nevertheless, the pain can persist for a long time and in some cases the vertebral body can collapse further, which leads to deformation of the spinal column. The repair of these crushed fractures through the use of balloons and application of quick-setting cement can prevent deformation and cause the pain to abate more quickly.

We distinguish between a fracture in patients with osteoporosis and in a normal vertebra.
Osteoporosis frequently occurs in the elderly age group, mostly in women after menopause. You can find a very extensive overview of the origin of osteoporosis and the dangers thereof at, among other places, www.osteoporosestichting.nl. Patients with osteoporosis are subject to easier fracturing of the wrist, hip or vertebra, mostly from a trivial fall.

When one sustains a crushing fracture of a vertebra, severe pain occurs. Treatment consists of bed rest, analgesics, and possibly wearing a corset. In most instances the pain subsides in a few weeks. Of course, the osteoporosis itself must be treated with chronic therapy (consult your general practitioner about this).

In certain cases a wait-and-see approach will not suffice, however: if the pain persists and is not under control or the fracture collapses further. One can monitor this by performing regular check-up radiography examination for a while. In these cases balloon vertebroplasty is recommended.

How is balloon vertebroplasty done?

The procedure is performed under general anaesthesia. Two cannulas (hollow tubes) are inserted along the back into the broken vertebra. One can do this safely by making extensive use of X-ray imaging during the intervention. A balloon is then inserted through these hollow tubes into the vertebra and inflated. In this way, the vertebra can be restored; it is “jacked up”, so to speak, and a space is created. After the balloons are removed, the space is filled with semi-set cement. Making a space and using this semi-set cement prevents the cement from running out of the vertebra or entering the bloodstream.

The cement hardens fully after a few hours and the patient can get up 12 hours later.
The results in patients with collapsed vertebrae are excellent: the pain is significantly better and further collapse, which could otherwise lead to pronounced hunching of the back, is avoided.

The same technique can be used for a traumatic vertebral fracture without osteoporosis. In younger patients, “biological” bone cement is usually used instead of actual cement of the type used for hip prostheses, for example. This is later reconverted into actual bone.

Recovery is more rapid for these patients as well, avoiding long-term immobility, pain and possible further collapse of the vertebra.
For more severe fractures a combination of an intervention and the use of screws and rods may be essential.

In conclusion, one can say that balloon vertebroplasty is a safe technique which offers a good solution for the treatment of painful vertebral fractures in both normal vertebrae and brittle vertebrae due to osteoporosis. In this way, prolonged hospitalisation and immobilisation, and especially further collapse and deformation of the spinal column, can be avoided!