Vertebroplasty of the spine (VP) is the restoration of the affected vertebrae by minimally invasive puncture surgery on the spine by introducing bone cement into them. It allows you to strengthen the structure of the destroyed vertebra, does not require large incisions, and is carried out transcutaneously (percutaneously). Most often recommended for compression vertebral fractures due to osteoporosis in the elderly.
Such fractures have a tendency to increase: if in 1990 1.7 million people suffered from them, then, according to experts, by 2050 the figure will increase to 6.3 million. In foreign countries, EP has been widespread since 1995, annually performed in Europe and the United States up to one hundred thousand such operations.
How is performed
For the operation, you need a special needle and radiography. Without fluoroscopy and CT observation, it is impossible to control the operation process. Methods of introducing cement depend on the affected area.
If the pathological process is in the lumbar and thoracic regions, the needle is transpendicular, and in the cervical region, the lateral one.
It is important to introduce the mixture in the state of its pastiness, after which it hardens after 6-11 minutes. In the polymerization process, PMMA is heated to 70 degrees. This gives support to the vertebra and it also allows you to have a cytotoxic effect, i.e., to resist the development of cancer cells.
Pluses of VP
Percutaneous vertebroplasty of the spine is highly effective in 90% of cases. Benefits:
- low risk of infection;
- simple elimination of complications;
- the area of anesthesia and the minimum length of hospitalization expands the circle of patients;
- minimal invasiveness;
- virtually no complications;
- Minimized incision reduces the possibility of bleeding.
From the history of discovery
The traditional conservative treatment of vertebral compression fracture is always very long and always leads to an increase in osteoporosis, severe congestive pneumonia, the formation of blood clots in the deep leg veins with the possibility of thromboembolism.
In France, in 1984, bone cement spinal surgery was performed for the first time in the world. Intervention was carried out for hemangiomas. After the operation, neurological symptoms completely disappeared and the tumor regressed. A few years later, American clinicians became interested in the method and modernized it for a wide range of indications.
Indications
Possible indications include:
- uncomplicated compression fracture at any level of the spine;
- the presence of progressive hemangiomas with a threat to the integrity of the vertebrae;
- partial vascular post-traumatic necrosis of the vertebra (Kyummel-Verney disease);
- vertebral osteoporosis that can provoke a fracture at any time;
- local metastasis to the spine (most often with thyroid cancer);
- split vertebra 1-2 degrees after an accident or fall;
- the lack of positive dynamics after conservative treatment, after which there is a violation of functions, pain, spinal deformity.
Contraindications
They are divided into absolute and relative. Absolute exclude the possibility of VP in general:
- vertebral osteomyelitis ;
- asymptomatic fracture of the vertebra;
- allergy to contrast or cementitious substance;
- uncorrectable blood coagulability;
- compression of the spinal cord after fractures with the development of myelopathy or radiculopathy;
- infectious foci in the spine;
- disorders of urination due to damage to the innervation of the spinal cord;
- paresis and paralysis of the legs.
Relative contraindications include:
- narrowing of the spinal canal in case of fracture by a bone fragment or tumor, but without neurological syndromes;
- laboratory signs of inflammation in myeloma;
- taking steroids.
Relative contraindications may be ignored by the surgeon if there are no other options.
Operation stages
The operation of vertebroplasty of the spine takes place under local anesthesia, in some cases, sedatives may also be administered intravenously:
- At the time of manipulation, a person lies on his stomach.
- The skin of the back is extensively lubricated with an antiseptic. Next, the doctor makes the correct anatomical markings on the skin for the correct introduction of the anesthetic and the correct insertion of the puncture needle.
- Next, infiltration anesthesia is administered.
- Then, under clear fluorographic control, a thin needle is inserted to the desired depth inside the affected vertebra (therefore, the intervention is also called puncture vertebroplasty of the spine). When the needle is inserted as accurately as possible, prepare the cement.
- After mixing with a PMMA mixer to a pasty state, it is immediately dosed into the vertebra.
- At the end of the manipulation, the needle is removed, and the wound is disinfected and fixed on top with a sterile patch.
The whole procedure takes 40-50 minutes. After 10 minutes, the cement hardens completely. The patient should lie on his stomach for another 2 hours. Then allowed to get up and move. If there are no complications and the patient feels well, he will go home on the same day.
Vertebroplasty with spinal hemangioma
With small asymptomatic hemangiomas, treatment is not necessary, only hemodynamic observation in dynamics. If the tumor size reaches 1 cm and pain occurs, vertebroplasty of the hemangioma of the spine should be performed. The technique is the same, but cement is already injected into the tumor cavity.
Bone cement for vertebroplasty
Polymethylmethacrylate (PMMA) or bone cement for orthopedic procedures is an expensive thing, so surgery is quite expensive. The drug consists of 2 components: a liquid monomer and a powdery polymer. In addition, an antibiotic is added to prevent infection and a contrast agent. They are connected with a special mixer just before the puncture. In this case, a thermal reaction occurs within 8-10 minutes. During this time, the neurosurgeon must have time to inject the obtained semi-fluid paste (t +55 ° C) precisely inside the problem vertebra. In total, no more than 4 ml of the substance is required.
Cement fills all defects from the inside, and the vertebra becomes a mega-durable joint that can withstand pressure of 100 atmospheres. He is not threatened with fractures. Cement is non-toxic and has excellent biocompatibility with bone structures, and there is no rejection reaction.
Complications after VP
The spine after vertebroplasty does not torment the patient in most cases immediately after surgery.
Algies after surgery are a rarity. Complications can arise when the cement-plastic treatment and poor-quality rehabilitation are performed incorrectly. Among them:
- local infection;
- seepage of part of cement into the spinal canal;
- allergy to the drugs used;
- radicular syndrome due to damage during surgery of nerve endings;
- the development of a connective hematoma as a result of damaged paravertebral vessels;
- with plastic surgery in the chest area, pleural damage (very rare).
Complications often occur with tumors of the vertebrae. If there is no symptom of deterioration when cement enters the canal of the spinal cord, treatment is not required. If the mixture is significant in volume, weakness may be noted in the arms and legs. Then you may need a second operation to extract the remnants of the mixture.
After the procedure
After vertebroplasty surgery of the spine, the patient is placed in a ward, where he is given analgesics and vital signs are monitored.
In the absence of negative reactions, the patient later leaves home. Further important:
- avoid getting wet wounds, making dressings in the first days after discharge;
- make regular dressings and processing of the section area;
- take antibiotics;
- exclude thermal procedures in the form of baths and saunas, insolation;
- You can not give any strain on the back.
the effect
Significant relief comes only a few hours after the CAP in 85% of patients (lack of pain and the possibility of active movements). The rest are improving gradually. The risk of complications is 2-5%.
At home, it is recommended that you follow these guidelines:
- temporary wearing a special corset to reduce stress on the spine and keep it in the correct position;
- in the first day after VP applying dry cool compresses to relieve pain;
- NSAIDs are possible;
- you can not lie for a long time in one pose;
- should periodically rest while walking.
VP categorically excludes the lifting of any weights in order to avoid repeated fracture of the vertebral bodies. After discharge, the patient should conduct exercise therapy regularly after discharge under the guidance of an instructor.
Vertebroplasty in Russia
VP in Russian neurosurgery began to be used not so long ago. In this direction, they specialize in RCH them. G. Kuvatova (Ufa) and FSBI “PFMITS” (Nizhny Novgorod). But the capital centers of vertebrology and neurosurgery are considered the best within the framework of the Russian Federation - the Research Institute named after Damaged and CST JSC "Russian Railways" (St. Petersburg), NMHTS them. Pirogov and Research Institute of Traumatology and Orthopedics (Moscow).
All clinics have the same requirements. The approximate cost of the operation is about 100 thousand rubles. In Moscow, the price of airspace is 150-180 thousand rubles. On the periphery of the airspace is an average of 85 thousand rubles.
According to reviews of vertebroplasty of the spine of patients who made it in Russia, the cost is not the same as quality.
Another problem - clinics are not available in every city. Rehabilitation for such patients is not well organized in Russia. This increases the percentage of complications. Therefore, while abroad complications are only 1-2%, in Russia this figure is increased to 4-7%. Today, there are not enough high-class specialists in this field in Russia.
Even anesthesia in Russian clinics during manipulation, as some reviews say about vertebroplasty surgery of the spine, does not give the proper and full effect. Therefore, treatment abroad is becoming the optimal choice for many.
To date, the Czech Republic is considered the standard of orthopedics and traumatology in the world. Prices are 2 times lower, and the quality is better. Doctors scrupulously and carefully approach each patient.
Full rehabilitation here is a prerequisite at the legislative level. Foreign medical service differs noticeably from Russian in its most competent approach, impeccable compliance with all operating standards, completely painless and comfortable surgery, and excellent persistent postoperative results.
Vertebroplasty for compulsory medical insurance in federal clinics of Russia, which provide the possibility of conducting EI on the insurance policy of compulsory medical insurance, is a rarity today. It is impossible to undergo vertebroplasty of the spine completely free even in these clinics. Here they may not take money for the work of a surgeon.
But for a set of one-time tools and bone cement will have to pay anyway. Prices depend on the manufacturer and range from 40 to 80 thousand rubles. By the way, preferential treatment for compulsory medical insurance for nonresident residents does not apply.
What is the situation in practice?
Reviews after vertebroplasty of the spine of patients who underwent this operation indicate that the treatment contributes to the complete disappearance of pain, a noticeable relief of the condition and restoration of movements. At first, some still continue to take painkillers, but the course of such a reception is short and does not require the use of particularly strong analgesics, since everything passes quickly.
Patients note that CAP is, indeed, the most effective method that alleviates the problem and justifies its high cost.
What else do patients say in their reviews after surgery for vertebroplasty of the spine? It is noted that the condition is completely stabilized after treatment in sanatoriums with rehabilitation and a course of massage. More reviews after vertebroplasty of the spine indicate that people are glad that they were not afraid to go for such surgery.
Vertebroplasty of the spine - rehabilitation
The treatment does not end at the operation. Further, mandatory full-fledged rehabilitation after vertebroplasty of the spine is required. If this is not the case, even with the most excellent operation, complications will develop and a whole bunch of problems will arise.
During rehabilitation, you can not:
- give increased stress on the body;
- to lie or sit for a long time;
- lift weights;
- engage in heavy sports.
Drugs against osteoporosis should be taken after the operation of VP necessarily.
It is recommended to begin rehabilitation after vertebroplasty of the spine most often with breathing exercises, moderate walking and isometric exercises. All this will help to normalize the state of muscles and maintain tone.
Later exercises complicate and increase their time. All exercises are assigned and supervised exclusively by the physical therapy instructor, with whom you must constantly communicate. It is very useful to go swimming after VP - this gives the greatest unloading of the spine.