Vertebroplasty is a minimally invasive, outpatient procedure for stabilizing compression fractures of the spine. Since it’s introduction in the United States in the early 1990’s, vertebroplasty has demonstrated its ability to help countless patients suffering from compression fractures reduce their pain by stabilizing the spine. The area of surgery will be sterilized, then a local anesthetic will be injected into the skin and deep tissues, near the fracture. A very small skin incision is made at the site. Using X-ray guidance, a surgical instrument called a trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra and a void is created with a void creation device. Medical-grade cement is injected into the fractured bone, then the trocar is removed and dressing is applied. The procedure is usually completed within an hour, unless multiple levels are being done.
- The procedure is done on an outpatient basis.
- An IV will be started, allowing a nurse to administer an antibiotic and sedation medication.
- The patient will be positioned face down for the procedure.
- The patient will be connected to monitors that track their heart rate, blood pressure, and pulse during the procedure.
The American Orthopedic Association developed Own the Bone as a quality improvement program to address the osteoporosis treatment gap and prevent subsequent fragility fractures. Through a clinically proven, web-based patient registry and 10 prevention measures, Own the Bone provides tools and helps institutions establish a fracture liaison service (FLS) in which a care coordinator (normally a nurse, nurse practitioner, or a physician assistant) ensures that post-fracture patients are identified and receive appropriate evaluation, diagnosis, and treatment, under the supervision of their primary care physician, orthopedic surgeon, or osteoporosis specialist.
The Colorado Spine Institute is committed to offering our patients the most innovative and safe spine and orthopedic care available using the latest in medical technology. Dr. Donner and his team have developed programs and procedures to optimize natural healing and reduce the need for more invasive procedures. Through the use of adult stem cells and other cellular components, we are able to treat orthopedic conditions in the spine, elbows, shoulders, hips, knees, ankles and SI joints. Contact us today to learn more about these exciting new options!
What is the purpose of the procedure?
The purpose of the epidural steroid injection procedure is to place a volume of long-acting cortisone around the spinal cord. This is to decrease the inflammation of the nerves. Its goal is to decrease your neck and/or arm pain.
How is it performed?
You will lay on your stomach on a special table, which allows for X-ray viewing of your spine. Your doctor will carefully and slowly anesthetize the injection site and place a small needle in the epidural space (space around the nerves). Often, a small volume of contrast will be injected to make certain the needle is in the correct position. At this point, the cortisone will be injected.
How long does the procedure take?
The procedure takes between five to 10 minutes to perform. You may be required to change into a gown and might need to stay a few minutes after the procedure before leaving. It would be best if you did not plan on driving home, but had a friend or relative come with you.
What are the risks?
The biggest risk from the procedure is that it will not help you to any great degree. The amount of pain relief you can expect from this procedure is extremely variable and cannot be predicted prior to performing it. The other most common risk would be that the needle is placed into where the nerves are, instead of around where the nerves are. If this happens, the needle will have gone through the dural membrane, similar to what happens when a myelogram is performed. The problem this presents is that you may develop headaches after the procedure, which could last several days and could even require a second procedure of placing blood from your arm into the area to produce what is called a blood patch. Please ask your doctor any questions you may have about these risks.
How well does an epidural steroid injection work?
This is extremely variable. It cannot be predicted who will benefit or for how long you may benefit from the injection. Often, it is done in an attempt to avoid a surgical approach. We generally perform one epidural steroid injection and would only consider a second if the first one was helpful for a period of time. Some doctors do a series of epidural steroid injections in rapid succession.
I have been scheduled for a discogram. Now what?
First, plan to bring someone to drive you home after the discogram. If you come alone, medication normally given to minimize procedural discomfort will not be provided. We want you to have a friend or relative in the room to observe your discogram. We give you medicine that may cause amnesia, and this person will be able to tell you what happened. We feel this is important.
We ask that you do not eat or drink anything four hours prior to the procedure (this includes gum, water, smoking, and hard candy). Also, make sure to bring all necessary insurance information for the registrar.
Please check in one hour prior to your scheduled discogram. If you are running late, or need to cancel your appointment, please notify us as soon as possible.
Discontinue all blood thinners (Plavix, Coumadin, Aspirin, etc.), as well as any vitamins (fish oil, omegas, Vitamin E, garlic, ginger, etc.). Anti-inflammatories should be discontinued ONE WEEK prior to procedure.
So, what’s the disc?
The disc is an oval-shaped soft structure that cushions and separates adjacent (bony) vertebrae. It has a firm outer ring called the annulus fibrosus and the center portion that is called the nucleus pulposus, which is often referred to as being “jelly like.”
What is degenerative disc disease?
This is a broad, non-descriptive term used to describe the “breakdown” of a spinal disc(s), which can result from defects one is born with and which may predispose a person to development of problems. It may also result from trauma, repeated spine injuries, smoking, and to some degree, the aging process.
This breakdown can result in narrowing of the disc space(s), cause abnormal spinal movement, and possible spinal nerve root compression. Back or neck pain is often the result of “unhealthy” discs.
What is a discography and a discogram?
Discography means “study of the disc.” and discogram means “picture of the disc.”
Why perform a discogram?
This test is the best way to determine which discs are normal or abnormal. It is done in an attempt to understand exactly where your pain is coming from, and to be certain that the disc above or below an intended fusion is normal. In general, do not undergo a discogram unless you are considering surgery.
How is a discography interpreted?
A number of factors are considered, which may include: 1) the amount of fluid that can be injected into the disc; 2) whether injection of a particular disc reproduces the same pain that brings you to see the physician; 3) the appearance of the disc on the subsequent X-ray pictures. Once the doctor has the results of your discogram, he or she will look at all of the information that has been gathered. These factors are interpreted, and recommendations will be discussed at your follow-up visit.
What are the significant potential risks associated with this procedure?
Soreness and increased low back or neck spasms are common complaints after this test. Fortunately, these usually pass within a few days. Pain medicine and muscle relaxants will be prescribed to ease these side effects.
A chief concern is the possibility of infection or inflammation of the disc, which may require other treatment. When any probe or other surgical instrument is put into the body, such as needles in this case, there is the possibility of breakage of the needle or injury to some adjacent structure or nervous tissue.
Allergic reactions to the dye or radio-opaque substance can occur. Any history of previous allergy to iodine-containing substances should be brought to the attention of the physician before this test. Serious complications are rarely seen. It is possible that the test may be inconclusive or that unforeseen complications may occur.
What are my other options or alternatives?
This study is an elective diagnostic test. Your other options include doing nothing, continuing with your existing limitations and capacities, or conservative therapy, bracing, pain management, and the use of certain medications as indicated on an individual basis.
How long does this test take?
Time is directly related to the number of discs to be studied. With this in mind, the study usually takes less than an hour. You will remain in the special procedures area for observation for a period of approximately 30 minutes after the study. A designated driver is required to accompany you and drive you home. If there is no designated driver available, pain medication or sedation will not be given.
Magnetic resonance imaging (MRI) is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body.
Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the magnetic field temporarily realigns hydrogen atoms in your body. Radio waves cause these aligned atoms to produce very faint signals, which are used to create cross-sectional MRI images — like slices in a loaf of bread.
The MRI machine can also be used to produce 3-D images that can be viewed from many different angles.