Question

Indications of vertebroplasty.

Hint:

Vertebroplasty is most effective in relieving pain and improving function in patients with osteoporotic and metastatic compression fractures, particularly when conservative management fails.

Answer 1

Step 1: Introduction to Vertebroplasty.
Vertebroplasty is a minimally invasive procedure used to treat vertebral compression fractures (VCFs) caused by conditions such as osteoporosis, trauma, or metastatic cancer. The procedure involves the injection of bone cement into the fractured vertebra to stabilize the bone and reduce pain.

Step 2: Indications for Vertebroplasty.

1. Osteoporotic Vertebral Compression Fractures:
Vertebroplasty is commonly indicated for patients with osteoporosis who suffer from painful vertebral compression fractures that do not respond to conservative management (e.g., medications, bracing, physical therapy). It is particularly useful in patients who experience severe pain and disability from these fractures.

2. Pain from Vertebral Fractures due to Metastatic Disease:
In patients with metastatic cancer to the spine, vertebroplasty can be used to provide pain relief and stabilize the vertebrae affected by metastatic lesions, improving quality of life in these patients.

3. Traumatic Vertebral Fractures:
Vertebroplasty is indicated for patients with traumatic vertebral fractures that have failed to heal with conservative treatment. This includes fractures due to high-impact trauma or falls in elderly patients, particularly when there is significant pain and functional impairment.

4. Multiple Vertebral Fractures Leading to Spinal Instability:
In cases where multiple vertebral fractures cause spinal deformity or instability, vertebroplasty may help restore structural integrity and alleviate pain, thereby improving spinal alignment and preventing further collapse.

5. Failed Conservative Treatment for Acute Vertebral Compression Fractures:
If conservative treatments, including rest, pain medications, and bracing, fail to relieve the pain of an acute vertebral compression fracture, vertebroplasty can be considered for patients who are candidates for the procedure.

Step 3: Contraindications to Vertebroplasty.
While vertebroplasty is highly effective for many patients, it is contraindicated in the following situations:
- Infection in the vertebral body or surrounding tissue.
- Presence of a large spinal tumor or tumor that involves the vertebral body, where stabilization alone may not be sufficient.
- Severe spinal deformity or instability that requires surgical intervention.

Step 4: Conclusion.
Vertebroplasty is an effective treatment for vertebral compression fractures, particularly in cases of osteoporosis, trauma, and metastatic disease. It is recommended for patients who have not responded to conservative treatment and experience significant pain or disability from their fractures.