Vertebroplasty, Kyphoplasty, Nucleoplasty

Vertebroplasty
Vertebroplasty - Images

Kyphoplasty
Kyphoplasty - Images

Percutaneous Discectomy (Nucleoplasty)
Percutaneous Discectomy (Nucleoplasty) - Images


VERTEBROPLASTY

Research indicates that osteoporosis can be caused by a diet lacking in calcium, excessive alcohol consumption (particularly in men), menopause, chronic steroid therapy and smoking.   It is estimated that 1 in 3 women and 1 in 8 men over the age of 50 has osteoporosis-worldwide.  Fractures, which result from abnormal bone thinning, can result in pain and disability.  Vertebroplasty and kyphoplasty are minimally invasive methods of treating patients with compression fractures of the spine.  A medical bone cement is injected into the collapsed vertebral body to stabilize and in some cases improve vertebral body height. Vertebroplasty can also be used to stabilize vertebrae affected by tumors such as hemangiomas, metastases, lymphoma or myeloma.  Patients are evaluated in our office and may undergo tests such as plain x-rays, CT scan or MRI of the spine to identify their condition. 

In most cases vertebroplasty is performed as day surgery with conscious sedation which includes IV medications for relaxation and pain control.  Patients are placed prone on the procedure table and given IV antibiotics.  After sterile preparation and administration of local anesthesia, a needle is placed in the affected vertebral body along the pedicles.  Under direct fluoroscopic visualization, a mixture of polymethyl methacrylate cement (PMMA) and an opacifying agent such as barium are injected into the bone.  When the appropriate amount has been administered, the needle is removed and a bandage is placed over the small incision.  Many patients experience instant relief of painful symptoms.  Patients are watched for several hours in the hospital and usually sent home the same day.


Vertebroplasty - Images

1) MRI shows bone edema and mild loss of height consistent with acute compression fractures of the T11 and L2 vertebral bodies. - 1) MRI shows bone edema and mild loss of height consistent with acute compression fractures of the T11 and L2 vertebral bodies. (1) MRI shows bone edema and mild loss of height consistent with acute compression fractures of the T11 and L2 vertebral bodies.

2) Flouroscopic images during the procedure show placement of the vertebroplasty needle on the left and localization of the pedicle on the right at L2.  (3, 4) Lateral image shows placement of both needles in the lateral plane and the next image shows delivery of methylmethacrylate into the vertebral body.  (3, 4) Lateral image shows placement of both needles in the lateral plane and the next image shows delivery of methylmethacrylate into the vertebral body. 
(2) Flouroscopic images during the procedure show placement of the vertebroplasty needle on the left and localization of the pedicle on the right at L2.  (3, 4) Lateral image shows placement of both needles in the lateral plane and the next image shows delivery of methylmethacrylate into the vertebral body. 

5) The needles are removed and the final AP image shows placement of the bone cement into the T11 and L2 vertebrae following treatment of both levels. The patient’s pain significantly improved. (5) The needles are removed and the final AP image shows placement of the bone cement into the T11 and L2 vertebrae following treatment of both levels. The patient’s pain significantly improved.


KYPHOPLASTY

Kyphoplasty is an alternative approach for treating painful compression fractures.  With kyphoplasty, a slightly larger needle is inserted into a vertebral body and under careful X-ray guidance place small balloons are directed into the bone.  The balloons are then inflated in small increments until certain endpoints are reached.  The balloons are then deflated and removed.  The acrylic bone cement is then placed into the spaces created by the balloons.  With kyphoplasty, patients are more often treated under general anesthesia and may stay overnight in the hospital.


Kyphoplasty - Images
1) Outside MRI of this patient showed edema in the T12 vertebral body consistent with acute compression fracture. 2) Flouroscopic images from the kyphoplasty show the needle position in the AP view along the upper outer margin of the pedicle of the T12 vertebral body.
(1) MRI of this patient showed edema in the T12 vertebral body consistent with acute compression fracture.  (2,3) Flourscopic images from the kyphoplasty show the needle position in the AP view along the upper outer margin of the pedicle of the T12 vertebral body.Lateral views show the balloon devices are inserted and then expanded to recreate the height of the vertebral body.  These are deflated and methylmethacrylate is delivered into the space to support the bone.

(4,5) The lateral and AP views show the final bone cement in place within the T12 vertebral body.


PERCUTANEOUS DISCECTOMY (NUCLEOPLASTY)

Pecutaneous discectomy is a minimally invasive procedure for the treatment of contained disc herniation.  Tissue is removed from the disc relieving pressure on the affected nerve.  It is used to treat patients with radicular pain related to a lateral disc herniation such as in sciatica.  It may also be helpful in patients with axial pain related to a disc protrusion against the posterior longitudinal ligament.  This method provides an alternative to standard spine surgery in properly selected patients.

Pain or weakness can be caused by a disc herniation pushing on a spinal nerve.  Physicians need to correlate clinical findings with MRI, CT/myelogram or discography prior to treatment.  Percutaneous discectomy takes about an hour to perform.  Patients are given conscious sedation and local anesthesia.  A needle is placed into the disc under fluoroscopic visualization, and a catheter like device is guided into the disc.  The disc is then treated by mechanical means, radio frequency or thermoelectric ablation reducing the size and pressure of the disc on the spinal nerve.  The device is removed and the small incision in the skin is treated by manual compression.  Patients will experience relief as pressure is taken off the affected nerve with published success rates greater than 80%.  Patients are kept in the hospital for several hours of observation.  Patients are discharged with instructions to gradually re-establish normal activity over the next few days.


Percutaneous Discectomy (Nucleoplasty) - Images
1) Sagittal CT scan shows a disc herniation at L4-5 after discograms were performed.  2) Plain film of the spine shows localization of the disc under flouroscopy.  The Nucleoplasty device has been placed into the disc for partial ablation to decrease pressure on the spinal nerves.
(1) Sagittal CT reformat image following discogram shows a disc herniation at L4-5. (2) Plain film of the spine shows localization of the disc under flouroscopy.  The Nucleoplasty device has been placed into the disc for partial ablation to decrease pressure on the spinal nerves.