This leaflet has been provided to help answer some of the questions that you, or those who care for you, may have about vertebroplasty and/or balloon kyphoplasty. Vertebroplasty is a medical procedure in which a fractured (broken) vertebra (back bone) is stabilised by injection of bone cement. Balloon kyphoplasty is similar except a balloon is used to try and restore the original shape of the fractured vertebra before the vertebroplasty procedure. What has NICE said? NICE (National Institute for Health & Clinical Excellence) recommends vertebroplasty and kyphoplasty (without stenting) as possible treatment options for some people with spinal compression fractures caused by osteoporosis (see below) Who can have vertebroplasty and kyphoplasty? You should be able to have vertebroplasty or kyphoplasty (without stenting) if: you have severe on going pain after a recent, unhealed fracture of the spine despite treatment for pain, and the pain has been confirmed to be where the fracture is. Why has NICE said this? NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. NICE recommended vertebroplasty and kyphoplasty (without stenting) because they work better than other treatments available on the NHS. Although they cost more than other treatments, this was justified by the benefits they provide. 1
The bones in your spine are called vertebrae and the front part is called the vertebral body. A vertebral compression fracture (VCF) occurs when the vertebral body fractures and collapses. Vertebral fractures may occur due to a condition called osteoporosis. Osteoporosis means porous bones and is a condition that affects the bones, causing them to become thin and weak making them likely to fracture. Figure 1 Normal Vertebrae Bone structure of normal vertebral body Figure 2 Compression fracture due to osteoporosis Bone structure of osteoporotic vertebral body resulting in a compression fracture Osteoporotic fractures are common in the elderly and particularly women, but can also be associated with other factors such as long-term treatment with steroids. Other causes of vertebral compression fracture include tumours affecting the spine. The aim of vertebroplasty is to reduce pain from vertebral fractures. Kyphoplasty may also reduce deformity and protect against new fractures. Vertebral compression fractures cause pain. They may also cause deformity, with increased spinal curvature leading to a hunched over appearance. This deformity itself can make further vertebral fracture more likely. 2
There are a few steps you can take to prepare for your examination, such as: Take your medications as usual, except blood-thinning tablets (such as warfarin, heparin, aspirin, plavix or clopidogrel) and metformin (a diabetes drug). If you take either of these it is very important that you tell the ward or imaging department staff before you come into the hospital, as you may need to stop taking them before your appointment. You may need to have some tests (such as a CT/MRI scan or blood tests) before you come for your procedure. If these have not been done in the clinic, they may be performed during your admission. We will ask you not to eat anything for four to six hours before your appointment time. However, you may drink water during this time up to two hours before. Your appointment letter will give you further information about this. This procedure is generally well tolerated and safe, but complications may occur in a small proportion of patients. There is a small risk (less than 1 in 1,000 or 0.1%) of infection in the vertebral body. There is a risk (less than 1 in 1,000 or 0.1%) of developing band like pain around the abdomen and down lower limbs. Rarely, there may be damage to the nervous structures in or around the spinal cord, which can cause pain for up to a few weeks. This is less than 1 in 1,000 (0.1%). Very rarely, there may be lasting damage to spinal cord which could cause paralysis, loss of bladder and bowel control. This is less than 1 in 1,000 (0.1%). Please telephone the ward where you are due to be admitted as soon as possible. We can then offer this date to another patient and agree a new appointment date and time with you. You will find the appropriate telephone numbers on your appointment letter. You are advised to travel, if possible, by public transport when visiting our Hospital. Car parking is severely limited and you may find it very difficult to find a place to park near the hospital. The nearest tube stations for Charing Cross Hospital are Hammersmith (District, Piccadilly and Hammersmith & City) and Barons Court (District and Piccadilly). Buses that stop outside the hospital are numbers 190, 211, 220 and 295. 3
You will be admitted to hospital and will be seen by the ward doctor and/or nurses before you come to the imaging (x-ray) department for your appointment. We will discuss the procedure with you in detail and ask you to sign a consent form. This is to make sure you understand the risks and benefits of having the procedure. You will also be seen by an anaesthetist prior to your procedure. This may happen on the ward or in the imaging department. Staff in the imaging department will then check your details and examine you before taking you into the x-ray room. The procedure is usually performed under general anaesthesia. You will be positioned on your side on the x-ray table. A small nick is made in the skin on your back and a hollow needle is passed into the fractured vertebra. The cement is then injected into the vertebral body under x-ray guidance. The needle is then removed and the small puncture wound is covered with a plaster. The whole vertebroplasty procedure usually takes about one to two hours depending on the number of vertebrae being treated. Balloon kyphoplasty is similar, except that a balloon is first inserted to expand the fractured vertebra and make space for the cement. Figure 4 Small balloon inserted into the collapsed vertebral body Figure 5 Balloon is carefully inflated to expand the fractured vertebral body Figure 6 The cavity is then filled with bone cement Figure 7 Cement in place to stabilise fracture vertebra 4
After the procedure, you will be transferred to the recovery room for about an hour, where a specially trained nurse will monitor your condition. Your family or visitors should be able to see you on your ward within an hour after procedure. Most patients are asked to get out of bed and walk with assistance on the first day of procedure and in most cases normal activities can be resumed within 24-48 hours. You may feel sore in your back where the needle was inserted for two to three days. Resume your regular medication but you may be able to reduce your painkillers. Do not drive for 24 hours. You can go home with an adult, if the distance is short. You will need to have a responsible adult to stay with you at home on your first day to ensure that you are alright. You may have a small amount of bruising on your back. However, if you notice any bleeding from the wound, you should lie down and press on it. Contact either your GP or go to your nearest accident & emergency (casualty) department if the bleeding continues. This will depend on how the procedure goes and the individual. Your consultant will advise you about returning to work and other activities such as participation in sport. You may also be asked to advise the DVLA (Driver and Vehicle Licensing Agency) Drivers Medical unit of your condition if you hold a driver s license. For further information, contact the DVLA on 0870 600 0301. Yes. The radiologist will write a report of the procedure that you have undergone and discuss it with your consultant. Frequently, the radiologist will discuss the results with you directly. Your follow up appointment will be decided after discussion at a multidisciplinary meeting. Your consultant will be able to advise you further. Please do not hesitate to contact us if you have queries or concerns: During working hour on Monday to Friday from 09.00 17.00 Imaging department Charing Cross Hospital Fulham Palace Road, London W6 8RF Telephone: 020 3313 0777 Or alternatively please contact your GP surgery. 5
If you would like to comment about your experience of our services and you would like to speak to someone other than staff caring for you, please contact the patient advice and liaison service (PALS) on either 020 3313 0088 (Charing Cross, Hammersmith, and Queen Charlotte s and Chelsea Hospitals) or 020 3312 7777 (St Mary s and Western Eye Hospitals). You can also email PALS at pals@imperial.nhs.uk. The PALS team will listen to your concerns, suggestions or queries and are often able to solve problems on behalf of patients. Alternatively, you may wish to express your concerns in writing to: Chief Executive Imperial College Healthcare NHS Trust Trust Headquarters The Bays, South Wharf Road London W2 1NY This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on 020 3312 5592. Imaging Published: July 2014 Review date: July 2017 Reference number: 2468v1 Imperial College Healthcare NHS Trust 6