Presentation
Severe diffuse back pain with history of old trauma. No sciatic pain.
Patient Data
Whole spine MRI study revealed diffuse osteoporosis and spondylodegenerative changes involving almost all of the dorsal and lumbar vertebrae. Multiple compression fractures and reduced vertebral height at multiple levels. Diffuse facet joint arthritis.
Fluoroscopic images of the dorsolumbar spine after the procedure showing symmetrical cement injection in each vertebra without cement leakage or any other apparent complication.
Follow up radiographs of dorsolumbar spine revealing good cement deposition and vertebral augmentation without any new vertebral collapse or fractures.
Case Discussion
Vertebroplasty (vertebral augmentation) is a minimally invasive procedure performed on collapsed vertebrae, most often in cases of diffuse osteoporosis, but also in cases of multiple lytic lesions, e.g. vertebral metastases, multiple myeloma. It is essentially "internal casting" for preventing further vertebral collapse.
In this case, whole spine MRI revealed diffuse spinal osteoporosis with multiple compression fractures with resultant reduced vertebral height.
The decision was to perform vertebroplasty on the most affected vertebrae to prevent further complications and give support to the intervening vertebrae. Vertebroplasty was performed from T6 to L5 with facet joint infiltration for pain relief during the same session.
The procedure in brief:
- performed under general anesthesia
- first, facet joint infiltration is achieved by insertion of spinal needles into the facet joints bilaterally under fluoroscopic guidance, then a mixture of local anesthetic, corticosteroid, and contrast medium is injected
- after accurate localization of entry points for each vertebra, the vertebroplasty needles (two for each vertebra) are introduced very slowly and cautiously into the vertebral bodies under continuous fluoroscopic guidance in AP and lateral projections (biplane angiography), to avoid neurological complication
- when the tip of the needle reaches the center of the vertebral body, cement injection is started; the injection process is done very slowly and carefully to avoid any cement leakage or intravasation
NB: The most important step in the procedure is the accurate insertion of vertebroplasty needles in the vertebral body. It should be done very cautiously and requires experience to avoid severe, irreversible neurological damage.
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