Multilevel vertebroplasty for osteoporotic crush fractures

Vertebroplasty (twelve vertebrae in a single session) with facet joint injection

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:

• Performedperformed under general anaesthesia.
• Firstfirst, facet joint infiltration is doneachieved by insertion of spinal needles into the facet joints bilaterally (T10-L5) underunder fluoroscopic guidance, then a mixture of local anaesthetic, corticosteroid, and contrast medium is injected.
• Then, after accurate localisation of entry points for each vertebra, the vertebroplasty needles (2 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.
• Whenwhen the tip of the needle reaches the centre 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.