#vertebroplasty

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Seek urgent care if you notice:

✓ New leg/arm weakness, foot drop or hand grip loss

✓ Bowel/bladder disturbance or saddle numbness

✓ Severe pain after a fall/accident

Book a routine consult if you have:

✓ Radiating pain (sciatica/cervical radiculopathy) beyond 2–6 weeks

✓ Claudication limiting walk distance despite therapy

✓ Recurrent flares affecting work, sleep or driving

Our Diagnostic Approach

Neuro-Ortho Exam

Power, reflexes, dermatomes and gait; red-flag screen and counselling.

Imaging

MRI as primary tool; dynamic X-rays for instability; CT for fractures/bony anatomy; DEXA in osteoporotic risk.

Conservative Window

Medication, PT, posture/ergonomics, work modifications and injections when indicated.

Surgical Plan

Decompression vs fusion decisions, navigation/IONM setup, anaesthesia and ICU plan, TPA/Aarogyasri authorisations.

Treatment Pathways

Microdiscectomy / Laminotomy

Laminectomy & Multilevel Decompression

MIS TLIF/PLIF Fusion for Instability

Cervical ACDF / Disc Arthroplasty

Vertebroplasty / Kyphoplasty

Spinal Tumor/Infection Decompression & Stabilisation

What to Expect: Your Care Journey

Spine Interventions, also called keyhole SPINE procedures are minimally invasive procedures where we don't have to open the spine to treat the disease. The special endoscope and other instruments are used to treat painful spinal disorders. Special X-Ray called fluoroscopy is used to visualize the spine from outside. With Spine Interventions, we can avoid more than 70% of spine surgeries. Most of the procedures are day care procedures or need just one day of admission.

Q. What all disorders can be managed with minimally invasive spine interventions.

Spine endoscopy is used to treat slipped disc and sciatica,

Biacuplasty or disc annuloplasty  is used for discogenic pain and to repair the disc tear

Vertebroplasty and Kyphoplasty for osteoporotic compression fractures of spine and spinal metastases of cancer,

Neurolytic procedures for cancer pain,

Radiofrequency ablation for joint pains,

Regenerative interventions for sports injuries and arthritis,  

Cooled radiofrequency for osteoarthritis knee pain, osteoarthritis hip joint pain and osteoarthritis shoulder joint pain.

Q How safe are these procedures?

A. As compared to surgery, safety is the biggest advantage. We don't have to open the spine, no bone cutting is required, hardly any blood loss. And the patient can go back home the same day. Most of the procedures are done under local anaesthesia and that adds safety to the procedures.

Q. How many days of rest are required after these procedures? Can I join my office after the procedure?

A. Usually, bed rest is not required. The patient can be discharged the same day and the patient can resume duties after the 3rd or 4th Day. Most of the non- endoscopy procedure patients can resume their duties even after one day of rest.

Q. Can these procedures also helps in pinched nerves or slipped disc and sciatica?

A. Yes, depending on the size of the disc herniation, we select the percutaneous procedure. In large herniations or big disc bulge, we remove the herniated portion of the disc or joint with spine endoscopy. For smaller herniation, some percutaneous procedures like, disc decompressor, laser discectomy, ozone discectomy or ozonucleolysis are selected.

Q. My MRI shows a tear in the disc. Can this be a cause of my back pain?

A. Disc tear or Annular tear is the most common cause of chronic back pain. Patients with annular tear will have pain after sitting for some time. They also feel pain and stiff back in the morning. Forward bending aggravates their pain. Now, with disc repair procedure, disc Annuloplasty or Biacuplasty where cooled RF (Coolief) is used to repair the damaged portion of disc without opening the spine.

Q. Are these spine interventions covered under medical insurance?

A. Yes, most of the procedures are covered under medical insurance. Currently, it is mandatory to admit the patient for one day in the hospital for insurance coverage. Soon, spine interventional procedures will also come under day care procedures.

Advanced age, asthma, diabetes, emphysema, menopause, chronic steroid use and rheumatoid arthritis are all risk factors for osteoporosis. The resultant weakening of bones can lead to compression fractures of the spine causing severe pain, deformity, loss of height, immobilization, and in some cases, failure to thrive.

Historically, vertebral compression fractures have been treated either with conservative methods of cast or brace immobilization with long term bed resting or with major surgery. This surgery requires a long incision, screws and rods for fixation and is done under general Anaesthesia. These treatments are limited by long recovery times and disruption of daily life.

Now, these painful spine fractures can be treated with a Minimally Invasive, Non Surgical procedure known as VERTEBROPLASTY, an innovative alternative to traditional treatments which stabilizes fractures of the spine safely and effectively, often providing immediate pain relief.

Q. Do we have any non-surgical procedure to fix spine fracture?

Vertebroplasty or targeted cementoplasty is one of the most advanced procedure for immediate and significant pain relief in patients with spine fracture or compression fracture due to osteoporosis. Osteoporosis is a condition where the bones becomes porous and fragile and leads to fracture with even minor trauma or jerk.

Q. How complicated is this vertebroplasty procedure for compression fracture of spine?

The procedure is very safe in experienced hands. There are costly options available but they have not proved to be more safer than vertebroplasty.

This procedure is done in Local anaesthesia, so we can even avoid the effects of general anaesthesia and patient can be discharged same day.

IPSC India is pioneer in performing this procedure.

Q. Is vertebroplasty a major surgery?

The goal of a vertebroplasty procedure is to stabilize the vertebral compression fracture to stop its painful movements. Vertebroplasty is considered a minimally invasive surgery because it is done through a small puncture in the skin instead of an open incision.

Q. Which procedure is better for spine fracture, Vertebroplasty or kyphoplasty.

Vertebroplasty and Kyphoplasty, both the procedures are done to fix the compression fracture of spine vertebrae. In Kyphoplasty, we use balloon to create some space inside the vertebrae and then fill that space with cement. But this makes kyphoplasty a difficult procedure as compared to Vertebroplasty and requires general anesthesia. Most of the recent studies have shown that there is no difference in outcome between the two procedures. Cost of the procedure is also less as compared to Kyphoplasty which is done under general anesthesia and may require hospital admission.

Q. What are the advantages compared to Surgical Fixation?

 Vertebroplasty has several advantages:

Do not require general anaesthesia.

No need to open spine.

No need to put rods and screws.

No need of prolonged hospitalization.

All these reduces the risk of complications.

Q. How long does it take to recover from vertebroplasty?

Most people are able to walk after the procedure, but you may need to restrict yourself to home for 24 hours afterward to rest. Then you can slowly resume normal activity. Some patients, but not all, feel pain relief soon after vertebroplasty. These patients report that their pain is gone or is much better within 48 hours.

At times, due to involvement of other nearby structures, pain relief is not complete after the procedures. In such cases, your pain specialist may advise another procedure like facet joint block or facet denervation, or myofascial trigger point injection.

Q. Can we use vertebroplasty for old age and osteoporotic spine?

Yes! percutaneous vertebroplasty can be performed in spinal vertebrae that are not suitable for surgical fixation, for instance because of osteoporosis or because general anaesthesia may not be advised in patients who are very sick.

This procedure can also be performed in spine fractures due to spinal metastasis. Some cancers at some stages of cancer, spread to other areas like spine.  These spinal pathologies are very painful and at times lead to fracture of spine.

Q. How this procedure is performed?

The beauty of this procedure is its simplicity. “A small needle is advanced into the fracture using only local anaesthetic followed by the placement of bone cement into the fractured area. The cement hardens in about 10-15 minutes and remarkably the pain is gone.”

“After performing good number of vertebroplasties, I can confirm that this is one of the most significant procedures for the treatment for vertebral compression fractures,”

Q. How long does bone cement take to set?

The calcium phosphate cement flows into the spongy inside portion of the bone, filling in microfractures and other damaged areas, and it hardens in about 10 minutes' time.

Dr (Maj) Pankaj N Surange

Interventional Spine and Pain Specialist

Dr. Swati Bhat

MD & Director (IPSC, South Zone)

Consultant, IPSC Bengaluru

Academic Head, IPSC Varsity and Training Institute

Neuro- Spine Interventional and Pain Specialist

What is osteoporosis?

Osteoporosis is a  condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D. Most often it happens as we age.

How does osteoporosis lead to spine compression fractures?

Compression fractures are tiny breakages in the bones in our spine. As we age these bones are more likely to break due to loss of minerals that give strength to the bone. Over time, breaks in the spine bones cause its collapse ,called as compression fracture.

What is the difference between compression fracture of spine and wedge compression ?

Compression fracture  is commonly caused by osteoporosis. A compression fracture  causes a collapse  in the spine bone and typically results in a reduction of vertebral height  around up to 20% because of the fracture and can happen in any area of the spine but most commonly occurs in the thoracic spine.  A wedge compression  is the most common type of fracture which involves the  front part of the vertebral spine where the rest of the spine is unaffected as it is considered mechanically stable without causing any spinal cord damage.

Why osteoporotic fractures don’t heal on their own?

Osteoporotic patients differ from normal population  as they have  poor bone quality due to mineral composition,  content, and crystallinity. This could be lack of  growth factors, and framework cells, and agents promoting bone formation and bone strength .Due to these reasons fracture healing in osteoporosis becomes a complex process of bone regeneration where healing does not happen the way it happens in normal healthy individuals and fractures may take longer time to heal or may not heal at all.

What is diff b/w vertebroplasty and kyphoplasty and  which is safe ?

Vertebroplasty is a procedure where the doctor injects the cement into the cleft or the space created by the fracture. This is achieved by taking several shots under the x-ray guidance called fluoroscope that helps to visualize the extent and spread of the cement with in the spine bone. kyphoplasty is also undertaken to correct the fracture with a technical difference that there is a mesh with in the needle used for cement injection which is targeted towards the fracture and expands as the cement is filled inside 

What is the success rate of vertebroplasty ?

Vertebroplasty has more than 90% success rate to relieve pain , which happens almost instantly after the procedure. However it may vary slightly depending on how many fractures are present and factors like presence of other spine conditions. In long standing cases, other areas of the spine also start generating pain. In such cases, pain relief is significant immediately after the procedure but it may take some additional time to relieve the pain of muscles and the joints.

My fracture is an old fracture. Can I still undergo vertebroplasty?

Usually vertebroplasty should be performed with in 1 to 2 months of an acute fracture . However, MRI scans can reveal the condition of an older fracture that needs or may benefit from vertebroplasty.

How long does it take to heal from vertebroplasty and kyphoplasty?

Both vertebroplasty and kyphoplasty can be done percutaneously which means through skin, not requiring any surgical incision, cutting of muscles or  bones and causing any blood loss. The patient can walk back home the same day of the procedure. The Interventional pain specialist performing the  intervention will brief you on the Do’s and Do Not’s after the procedure in the immediate post procedure days.

What can you not do after vertebroplasty ?

You may be advised  to lie down in the bed after the procedure not allowing you to sit upright for 4-5 hrs. Bending or twisting the spine is avoided in the immediate recovery period for  few days .Lifting heavier objects is also avoided.

I have a spine metastasis. Can vertebroplasty cure my cancer spread?

Some cancers, such as lung, breast and thyroid cancer, often metastasize to the bones and spine leading to pain and collapse of the bones. In such patients, thermal ablation methods such as radiofrequency, microwave or cryoablation can be applied to the metastasis mass first, then vertebroplasty is performed through the same needle. The pain-reducing effects of both ablation and vertebroplasty may be increased when used together. But vertebroplasty cannot cure or stop the spread of cancer cells which may have its primary cancer source elsewhere.

How Painful is the procedure?

A percutaneous vertebroplasty can be a painful procedure but the procedure is performed under local anesthetic given at the skin deep down upto the bone where the fracture is to be corrected. This makes this extremely painless and safe as the risk of anesthesia is totally avoided.

Is vertebroplasty safe for elderly ?

Yes , it is completely safe for the elderly to undergo vertebroplasty .Elderly patients often have comorbid conditions like  diabetes, hypertension, cardiovascular and cognitive  problems which may make anesthesia extremely challenging requiring icu stay, prolonged hospitalization and recovery , but all of this can be avoided by doing percutaneous vertebroplasty .

What are the side effects  after vertebroplasty?

Cement leak is one of the complications which can be avoided by making proper assessment of the fracture before doing the procedure. This is often done by carefully examining the patient and checking the scans thoroughly , and maintaining caution during the cement injection .Minor complications like bleeding and infection can be avoided in almost all patients by following standard protocols before any intervention major or minor.