Osteoporosis – is an urgent problem in modern medicine. Its prevalence is quite high. About 40 out of 100 women and 13 out of 100 men over 50 years of age suffer one or more skeletal fractures associated with osteoporosis. The disease develops gradually, most often manifesting as so-called osteoporotic fractures. The most common pathological fractures associated with osteoporosis are vertebral body fractures.

Local pain accompanies 84% of vertebral fractures in osteoporosis. The duration of the pain syndrome is at least 4–6 weeks, but despite traditional therapy, full regression is often absent due to residual deformation of the vertebral body and impaired support function.

Without proper treatment, vertebral fractures due to osteoporosis significantly worsen patients’ quality of life, causing severe pain syndrome, depression, insomnia, neurological deficits, and reduced work capacity. The presence of multiple compression fractures of the vertebral bodies can lead to poor posture, kyphosis formation, and decreased lung vital capacity.

Traditional methods for treating vertebral body compression fractures include analgesics, muscle relaxants, immobilization, bed rest, physiotherapy, and wearing an external corset. However, prolonged bed rest and lack of early mobilization due to severe pain lead to loss of appetite, constipation, impaired glucose tolerance, development of hypostatic pneumonia, phlebothrombosis, and, ultimately, pulmonary embolism. In addition, due to reduced load during bed rest, bone density decreases (up to 2% per week), and osteoporosis progresses.

VERTEBROPLASTY – A MINIMALLY INVASIVE METHOD FOR TREATING VERTEBRAL BODY FRACTURES

Compression fractures of the spine are a fairly common complication in patients with osteoporosis. Even minor loads can flatten the vertebral body (loss of its height). Every year, over 1,500,000 people suffer osteoporotic compression fractures of the spine. These fractures cause increased kyphosis (hunchback), severe pain, and often lead to an inability to lead a normal life.

THE ESSENCE OF THE PROBLEM:

The main component of the spine is the vertebra. Compression fractures destroy it. A crushed vertebra gives the spine an oblique appearance called kyphosis, and the loss of height (due to a flattened vertebra) causes contraction of the paravertebral muscles. This increases pressure on antagonist muscles, causing muscle fatigue and pain.

WHAT DO SURGEONS DO?

In the past, surgeons used standard open surgery to repair compression fractures caused by osteoporosis. Open surgery requires wide incisions for necessary access. Operations often did not achieve the desired results, mainly due to the complexity of operating on soft, weak osteoporotic bones. Additionally, many patients with fractures are physically unable to tolerate such surgeries. Vertebroplasty allows surgeons to repair the broken bone without the complications of open surgery. Unlike open surgery, vertebroplasty is a minimally invasive procedure that reduces the risk of bleeding, infection, and muscle and tissue injury.

SPINAL VERTEBROPLASTY:

This minimally invasive method is most effective in treating vertebral hemangiomas. Its main clinical benefit is near-instant pain relief and improved quality of life.
The method can be used for treating uncomplicated vertebral fractures and prophylactically to strengthen vertebral bodies at relatively high risk.

METHOD DESCRIPTION:

Percutaneous vertebroplasty involves inserting a metal needle into the vertebral body, through which a mixture of PMMA-based bone cement, antibiotic, and contrast material is injected under fluoroscopic and CT control. The needle is inserted transpedicularly for thoracic and lumbar pathology. For cervical-level lesions, an anterolateral approach is used.

The setting speed and working time of PMMA are critical, as this period (6–11 minutes) is allocated for injection and filling the pathological cavity or fracture. As the bone cement polymerizes, it heats up to 70°C, providing a cytotoxic effect on tumor cells and supporting the affected vertebral body. Once hardened, the cement reinforces the vertebra, allowing effective treatment not only of osteoporotic compression fractures but also of pain caused by vertebral hemangiomas or spinal metastases.

This method is definitive and, if performed correctly, does not require re-injection of bone cement. Rejection of the bone cement never occurs.

INDICATIONS FOR PERCUTANEOUS VERTEBROPLASTY:

  • Vertebral tumors (aggressive hemangiomas, myelomas, osteolytic lesions)
  • “Critical” osteoporosis of the spine
  • Traumatic lesions
  • Fresh, uncomplicated stage I compression fractures of vertebral bodies
  • Post-traumatic osteonecrosis (Kümmel disease)

CONTRAINDICATIONS TO VERTEBROPLASTY:

  • Severe general condition of the patient (critical blood coagulation disorders, decompensated cardiovascular and respiratory failure)
  • Nature and extent of vertebral body lesions
  • Significant reduction (>70% of original) in vertebral body height
  • Extravertebral spread of the process
  • Multi-level involvement
  • Infectious lesions of the vertebral bodies