Treatment of spinal fractures by injecting cement to stabilize the spine (Balloon Kyphoplasty)

You have been diagnosed with a vertebral compression fracture, which requires treatment by vertebral cement injection to reduce pain and increase the strength of the fractured or collapsed vertebrae. Before this treatment, the surgeon will explain the vertebral cement injection procedure, the possible outcomes, and risks of the injection. At the same time, you will be informed of other treatment options, allowing you to decide on the treatment method. Today, Dr. Theerasak Phuengngam, a specialist in brain and spine at Phyathai 1 Hospital, will provide information about treating vertebral fractures by vertebral cement injection to help you prepare for the cement injection treatment.

Diseases or Conditions Treatable by Vertebral Cement Injection

1. 1. Treat severe pain caused by vertebral compression fractures due to osteoporosis.
   2. Treat severe pain caused by vertebral compression fractures resulting from accidents or to reinforce vertebral strength during spinal surgery or spinal fixation with metal implants.
   3. Vertebral compression fractures caused by tumors within the vertebrae.

Treatment Options

Treatment approaches for vertebral compression fractures are as follows:

• • Conservative treatment involves bed rest and taking or injecting painkillers for 1-2 weeks. The fractured vertebra can heal on its own within 2-3 months. However, this method cannot treat patients with nerve or spinal cord compression from fractured bone fragments, displaced vertebral fractures, or vertebral compression fractures caused by tumors.
  • Vertebral cement injection treatment (Balloon Kyphoplasty) is used when conservative treatment with bed rest and painkillers is ineffective, the fractured vertebra has not healed, or pain persists for many days.
  • Surgical treatment involves repositioning displaced vertebral fractures, fusing vertebrae, and fixing vertebrae with metal implants. Surgery can also remove bone fragments compressing the spinal cord or nerves. This is indicated only for cases requiring surgery, especially those with symptoms such as numbness, weakness in legs or feet, or problems with urination or defecation. In some cases caused by osteoporosis, surgery requires additional vertebral cement injection to reinforce the bone.

In cases of vertebral compression fractures or breaks caused by tumors, especially cancer requiring tumor removal and spinal fixation with metal implants, vertebral cement injection not only reinforces the vertebrae but also helps relieve pain caused by tumors in the vertebrae.

Vertebral Cement Injection Procedure

The vertebral cement injection procedure can be performed under local anesthesia without general anesthesia or under general anesthesia. The choice depends on the patient’s condition, the amount of cement needed, and how long the patient can tolerate lying face down. If general anesthesia is required, the anesthesiologist will provide detailed information about the anesthesia to the patient.

The vertebral cement injection procedure (Vertebroplasty) involves the patient lying face down on the operating table. A needle is inserted into the vertebra, guided by X-ray/fluoroscopy to locate the injection site. A small incision of about 2-3 millimeters is made at the needle insertion site. The needle is then inserted into the vertebra, and a contrast agent is injected to check if the injection site is safe and to assess the risk of cement leakage pressing on the spinal cord. Once the correct and appropriate site is confirmed, cement is injected into the vertebra to stabilize the fractured vertebra or reinforce the bone. During the injection, the doctor continuously monitors the X-ray images on a screen. After the cement injection, the patient is turned onto their back and lies supine for about 2-3 hours to allow the cement to harden. Afterward, the patient can sit or stand. This method does not restore the height of the compressed vertebra.

Vertebral cement injection with vertebral height restoration (Kyphoplasty) is a method that can restore the height of the compressed vertebra close to normal levels by using an inflatable balloon or expansion tool inserted into the compressed vertebra through the cement injection needle, then injecting cement to stabilize the vertebra.

Image showing the lying position during vertebral cement injection

Image showing the injection site of vertebral cement in a compressed vertebra

Image showing the operating room and X-ray machine preparing the patient for vertebral cement injection

Illustration showing balloon insertion to expand the compressed vertebra

Possible Complications

Despite careful planning and precautions, the following complications may still occur:

1. 1. Blood loss or heavy bleeding from the vertebra, which is very rare.
   2. Rib fractures, mostly occurring in patients with osteoporosis, but this is very rare.
   3. Fracture of the vertebra at the needle insertion site causing increased pain, treated with painkillers and bed rest.
   4. Pneumothorax (air leakage into the chest cavity) caused by the needle puncturing the lung, which is very rare and treated by inserting a chest tube to remove air.
   5. Fever, chills, and increased pain after vertebral cement injection, which is temporary and caused by heat generated as the cement hardens.
   6. Cement leakage irritating or compressing spinal nerves, causing pain along the affected nerve, treatable with pain relief medication.
   7. Cement leakage compressing the spinal cord, a rare but severe complication that can cause paralysis of both legs and loss of bladder and bowel control, requiring emergency spinal surgery to remove cement fragments pressing on the spinal cord.
   8. Cement leakage into veins around the vertebra, traveling to the lungs. Most cases are asymptomatic, but large amounts of leaked cement can cause circulatory problems or be fatal. This complication is extremely rare.
   9. Infection, divided into two types: skin infection and deep-seated infection. Skin infections can be treated with wound cleaning and antibiotics. Deep infections involving vertebrae or intervertebral discs may require surgery if antibiotics fail. Bloodstream infections are very rare.
   10. Allergic reactions to medications, anesthesia, or contrast agents used in X-rays, presenting as itching, skin redness, swelling, inflammation, and nausea. Severe reactions may cause low blood pressure, seizures, or respiratory arrest, requiring emergency treatment in an intensive care unit.
   11. Skin scarring, similar to surgical scars. Scars may be raised, large, or cause chronic pain depending on individual or genetic factors.