Vertebroplasty in the treatment of osteoporosis patients

Causes of osteoporosis can be divided into primary and secondary. Primary osteoporosis occurs due to aging and changes in female hormones after menopause, so it is more common in older men and women after menopause; while secondary osteoporosis is caused by other endocrine diseases and blood diseases. , cancer, drugs, hereditary diseases, and gastrointestinal diseases, causing damage to bone cells and leading to bone loss.

In Taiwan, the average incidence rate of spinal bone lesions caused by osteoporosis among people over 65 years old is 18.1%, while the incidence rate is 12.9% in men and 23.8% in women. There are approximately 60,000 vertebral fractures caused by osteoporosis every year, and most of these fractures are compression fractures. Such vertebral compression fractures often occur only due to minor falls or accidental falls, and are often accompanied by severe back pain. The pain is often aggravated during activity, making the patient unable to move and affecting daily life.

In the past, treatment methods usually relied on conservative therapies such as analgesics, bed rest, and the use of braces, which often required four to six weeks of convalescence. Severe cases were even bedridden and required hospitalization, causing further damage to the vertebral bones. Porous fractures may cause complications such as pneumonia and deep vein thrombosis. If the patient suffers from nerve compression symptoms, surgical treatment is required. In the past, the surgical method was mainly nerve decompression surgery or combined with traditional spinal fixation surgery. However, due to the patient's own vertebral osteoporosis, the fixation of the fixation on the vertebral body was difficult. The effect is not good and it is difficult to obtain the expected therapeutic effect.

In order to more effectively resolve the pain of such patients, neurosurgery has introduced vertebroplasty. This surgery inserts artificial bone cement (PMMA) into the damaged vertebral body to enhance the strength of the vertebral body and the stability of the spine, thereby reducing the chronic pain caused by the damage to the vertebral body.

This surgical treatment method was first performed by Galibert et al. in France in 1984. It was used to treat spinal vertebral hemangioma to prevent further destruction of the vertebral body and enhance spinal stability. At present, this treatment method has been widely used in the treatment of various compression fractures caused by primary and secondary osteoporosis. This method is also quite effective in treating pain caused by primary tumors, including hemangioma, myeloma, lymphoma and spinal metastasis cancer. Recent studies have shown that percutaneous vertebroplasty is 70-90% effective in providing pain relief.

Vertebroplasty can be performed by percutaneous puncture into the vertebral body, or it can be performed at the same time as spinal decompression surgery. Patients undergoing percutaneous bone cement placement can be placed under local or general anesthesia.

Surgery steps:

1. Antibiotic treatment will be given before surgery.

2. With the patient lying down, disinfect the surgical site.

3. After local anesthesia, under the guidance of computer tomography or X-ray machine (fluoroscopic C-arm), insert the No. 11 to No. 13 bone marrow needle through the skin to reach the front 1/3 of the vertebral body.

4. After stirring the bone cement, barium agent with developing effect and base liquid evenly, inject about 4-10ml of artificial bone cement into the collapsed vertebral body.

5. After the operation, compress the wound for 10 minutes. After the artificial bone cement has hardened, the patient will be moved to lie down. After the anesthesia subsides, the patient will be sent to the recovery room for observation, and then returned to the ward after the condition is stable.

6. After the operation, when the pain is relieved (on the day of the operation or the next day), the patient is encouraged to use a back brace to get out of bed and move around. If the condition is stable, the patient can be discharged and return to the outpatient clinic for follow-up review.

Risks of surgery and possible complications:

Any surgical treatment has its risks and possible complications, and vertebroplasty is no exception, with possible complications (less than 10%).

1. Risks of local or general anesthesia.

2. Risks of the surgical procedure:

· Increased pain.

· Nerve roots are damaged during guide needle insertion (less than 4%).

· Spinal cord compression causes neurological deficit (leakage of artificial bone cement, less than 0.5%).

· Bleeding and infection at the surgical site.

· Rib fractures (rare).

· Surgical mortality (rare).

·Pulmonary embolism (leakage of artificial bone cement, rare).

· The incidence of adverse reactions caused by non-ionic contrast media is less than 0.7%, and the mortality rate caused by non-ionic contrast media is less than 1/250,000.