Multilevel vertebroplasty for osteoporotic crush fractures

BoneVertebroplasty (vertebral augmentation technique is considered) is a minimally invasive procedure of choiceperformed on collapsed vertebrae, most often in cases of diffuse osteoporosis to give more bone support and stability specially in weight bearing bones as vertebral column. It is essentially "internal casting" for preventing further vertebral collapse.

In this case of 77 y female , MRI study of the whole spine MRI reveled  diffusediffuse spinal osteoporosis and spondylodegnerative changes involving almost the whole thoracic & lumbar vertebrae with multiple compression fractures andwith resultant reduced vertebral height associated with diffuse facet joint arthritis.

The decision was to perform vertbroplasty to the most affected vertebrae to prevent further complications and to give more support to the vertebrae in between , so weinbetween. Vertebroplasty was performed it from D6 tillT6 to L5 with facet joint infilterationinfiltration at the same session tofor pain relief the patient symptoms.

The procedure in brief:

•  Procedure was performed Performed under general anaesthesia.
• First, first of all facet jointsjoint infiltration wasis done by insertion of spinal needles insideinto the facet joints bilaterally ( from D10 till L5(T10-L5) levels under under flouroscopic guidenceguidance, then thea mixture of local anaesthetic, corticosteroid &, and contrast mediamedium is injected inside.
• Then, after accurate localizationlocalisation of entry points of Thefor each vertebra, the vertebroplasty needles (2 for each vertebra, the needle is) are introduced very slowly & causiosly inand cautiously into the vertebral bodies (2 in each vertebra ) under continuous fluoroscopic guidance in A-P &AP and lateral projections (biplane angiography system), whento avoid neurological complication.
• When the tip of the needle reaches the centre of the vertebral body, we startcement injection of the cement (which is already prepared), thestarted. The injection process should beis done very very slowly and carefully to avoid any cement leakage or intravasation.
• The key point of this procedure is the accurate insertion of the vertebroplasty needle in the vertebrae, which should by done precisely with high experience to avoid severe neurological complications..

wholeWhole spine MRI study revealed  diffusediffuse osteoporosis and spondylodegnerativespondylodegenerative changes involving almost all of the whole dorsal &and lumbar vertebrae with multiple. Multiple compression fractures and reduced vertebral height at multiple levels associated with diffuse. Diffuse facet joint arthritis.

fluoroscopicFluoroscopic images of the dorsolumbar spine in (A-P and lateral views) after the procedure showing symmetrical cement injection in each vertebra without cement leakage or any complicationsother apparent complication.

Follow up X-ray imagesradiographs of dorsolumbar spine revealing good cement deposition and vertebral augmentation without any new vertebral collapse or fractures.