Vertebroplasty / Cementoplasty

Vertebral compression fractures are common in older adults. They correspond to fractures of the vertebral bodies, most often due to osteoporosis (bone fragility from demineralization) and sometimes secondary to a bone lesion.

These fractures frequently occur after a simple fall from standing height.

1 in 4 women over 65 will develop an osteoporosis-related vertebral fracture.

Vertebroplasty, also called cementoplasty, is a minimally invasive technique initially developed in the mid-1980s. It consists of injecting medical cement into a vertebra.

Kyphoplasty is a variant of cementoplasty aimed at restoring vertebral height in addition to cement injection.

The main indication is a recent vertebral fracture (also called a compression fracture), most often of osteoporotic origin.

Other indications include:

• Osteoporotic sacral fractures
• Painful malignant bone tumors
• Certain benign tumors (hemangioma)

The procedure takes place in an interventional radiology suite meeting hygiene standards. Total duration is approximately 1 hour.

1. The patient lies on their stomach. A micro-incision (<1 cm) is made in the skin to allow passage of a cannula.
2. Under continuous radiological guidance, cannulas are inserted into the vertebra.
3. Once in place, cement is injected in liquid form until satisfactory filling of the vertebra is achieved.
4. The procedure can be repeated at other levels in case of multiple fractures.

No. The procedure is performed under sedation with an anesthesiologist present.

If general anesthesia is contraindicated, the procedure can be performed under local anesthesia with the same results.

Immediate recovery: The patient must observe strict bed rest for approximately 2 hours while the injected liquid cement hardens within the vertebra. After this period, the patient may get up.

Discharge home is planned either the same evening or the next day, depending on the patient and the care facility.

Long-term follow-up: In the context of osteoporotic fractures, it is essential to be managed by rheumatology colleagues for a comprehensive assessment of factors that may have contributed to the fracture. This includes blood tests, bone densitometry, and correction of certain deficiencies.

20% of patients will develop a new vertebral fracture within the following year.

The risks of vertebroplasty are low but exist, as with any procedure.

The main complication is related to cement leakage outside the vertebral body. When it occurs, it is most often asymptomatic. The best way to prevent these leaks is real-time monitoring of cement injection under radiological guidance.

Other complications include pain at the puncture site, infection, and hematomas along the tract.

The alternative to treating osteoporotic fractures with vertebroplasty is analgesic treatment that may include morphine, rest, and wearing a brace for 6 weeks to 3 months.

• Vertebroplasty provides rapid, almost instantaneous pain relief.
• It allows patients to discontinue analgesics and their side effects.
• It enables a rapid return to activities, unlike a brace which must be worn for 6 weeks to 3 months, often with poor tolerance and discomfort.
• Back musculature, often neglected, is not affected thanks to early mobilization, whereas immobilization has a harmful effect.
• The fracture is stabilized immediately, whereas brace treatment can fail to achieve consolidation.

Treatment of osteoporotic fractures with vertebroplasty reduces mortality risk by 22% compared to untreated patients. Results from a study published in 2020.

This is a commonly held belief without scientific evidence (VERTOS IV study). In our practice, we sometimes observe new vertebral fractures occurring after vertebroplasty. The confusion arises from the fact that 20% of patients who have had a vertebral fracture will develop a new fracture within the following year, with or without vertebroplasty.

This phenomenon is well known: the "fracture cascade." To prevent it, it is important to be managed by a rheumatologist to address the underlying disease, osteoporosis.