Vertebroplasty

Vertebroplasty is a medical procedure that is employed to treat compression fractures in the vertebrae. The procedure involves injecting medical grade bone cement into the vertebral bones that have been damaged or collapsed. This procedure offers support. Osteoporosis is the most common cause for fractured spine bones. Spinal tumors, traumatic injuries and rarely Hemangioma are some of the other causes for vertebral compression fractures (VCF) of the spine. However osteoporosis-led vertebral fracture is the most common clinical situation in which vertebroplasty is used. These fractures cause severe pain and reduce the mobility of the patient. Vertebroplasty is a recently developed image-guided surgical procedure with minimum invasion that promises faster pain relief. Vertebroplasty becomes the best alternative choice when conservative pain management does not provide relief to the patient. It is a simple day-care procedure that not only helps in stabilizing the broken bone but also prevents further compression of the affected vertebral area.

Vertebroplasty Procedure

An MRI scan is performed on the patient prior to the procedure to confirm the fracture. If MRI scan is not recommended for the patient due to any specific medical condition, CT scan is carried out to assess the exact location of the fracture. If the patient is on any kind of medication, it should be informed to the doctor. Anticoagulation medicines or blood thinners have to be stopped at least five days before the surgery. Vertebroplasty is performed under local anesthesia with sedation by an Interventional radiologist or neuroradiologist. He should be well trained in fluoroscopically guided needle placement and should be able to deliver the cement to the exact position skillfully.

The patient is made to lie face down during the procedure. A small hollow point needle is positioned into the crushed bone. The doctor navigates the needle into position using a . Once the needle is in position, bone cement is directly injected into the collapsed bone to secure it. It is a special cement called polymethylmethacrylate (PMMA) that hardens within 10 to 20 minutes and restores the strength and shape of the vertebrae alleviating the pain caused due to compression. Though PMMA cement is the most widely used ingredient to repair vertebral fractures, other new substances such as cortoss (an injectable, non-resorbable, polymer composite that is designed to mimic cortical bone) are being explored in place of PMMA cement as excess polymethylmethacrylate cement can become toxic in the body. More than one fracture can be fixed at the same sitting. Vertebroplasty reduces the pain instantly and helps the patient to return to normal activity in a short period of time. Few hours of rest is recommended soon after the procedure; however the patient can be discharged the same day.

Vertebroplasty is generally a safe procedure. But in rare cases, the cement may leak into adjacent areas leading to complications. If the leaked cement enters the vein and travels to the lungs, it will cause serious pulmonary problems. In worst cases, cement leak may press upon the spinal cord or compress nerves leading to nerve damage. It may also require further surgery to treat the condition. Possibility of infection, allergy and bleeding are some of the other risks associated with Vertebroplasty. Vertebroplasty is not a recommended treatment for herniated disks or arthritis related back pain.

Arthrogram

An arthrogram is a diagnostic x-ray of joints to assess the cause of any problems. Arthograms are often taken on hip, knee, ankle, wrist and shoulders. An arthogram provides images of soft tissues and joint capsules. In cases of explained joint pain or inflammation, arthogram is done to identify any problems with ligaments or cartilage or abnormal placement of bones. Abnormal cysts or growths can be identified with the help of arthogram. If the patient is pregnant or allergic to iodine, the radiologist must be informed.

A patient undergoing an arthogram is asked to place the affected joint under a fluoroscope. The contrast material is injected into the joint to enable it to be viewed. An MRI arthogram involves x-rays and MRI. MRI and CT scan are used when an arthogram does not provide any clear diagnosis. There might be mild swelling and tenderness in the joint that has been subjected to arthogram. Rare complications of arthograms are infection in the joint and damage to the internal structure of the joint.

Fluoroscopy

Fluoroscopy is used to study moving body structures. An x ray beam is continuously passed into the body part to be examined it is transmitted to a TV-like monitor so that the body part in motion is studied in detail. As an imaging technique, fluoroscopy is commonly employed by physicians to obtain real-time images of the internal structures of a patient during minimally invasive and microscopic surgical procedures, as well as many types of diagnostic tests like discography.

Fluoroscope: In its simplest form, fluoroscopy consists of an x ray source and a fluorescent screen between which a patient is placed. Modern fluoroscopes couple the screen to an X ray image intensifier and a video camera allowing the images to be played and recorded on a monitor. Traditional fluoroscopes consisted of an x ray source and fluorescent screen between which the patient was placed. Modern fluoroscopes have shown several improvements in screen phosphors, image intensifiers and even flat panel detectors. These allow for increase quality while minimizing the radiation dosage to the patient. Modern fluoroscopes also use the CSI screens and produce noise-limited images. This ensures minimal radiation dosage results while still obtaining images of acceptable quality.

Fluoroscopy can be adopted on an inpatient or outpatient basis. Depending upon the specific type of procedure or examination, it is determined whether any preparation prior to the procedure is required. All fluoroscopic procedures pose potential health risk to the patient. Fluoroscopy uses more radiation than standard x rays. Radiation doses depend upon the size of the patient as well as the length of the procedure. Fluoroscopy is widely used in orthopedic surgery to guide fracture reduction and the placement of metal work. Fluoroscopy is used in many diagnostic and therapeutic radiological procedures to observe the action of instruments being used either to diagnose or to treat the patient. Fluoroscopy is also used to help find a foreign object in the body, position a needle for a medical procedure or re align a broken bone. Different types of fluoroscopy procedures:

• Esophogram: x ray study of the throat.
  
• Upper GI series: is a study of the esophagus, stomach and duodenum.
  
• Small bowel series: is a study of the stomach and entire small intestine.
  
• Barium enema: is a study of colon.
  
• Hysterosalpingogram: is a study of the uterus and fallopian tubes.
  
• Intravenous Pyelography: is a study of the kidneys, ureters, and the urinary bladder.
  
• Voiding cystourethrogram: is the study of the bladder and urethra.
  
• Arthrogram: is a study of the shoulder and knee joint showing ligament and tears.
  

Tags: #Vertebroplasty #Arthrogram #Fluoroscopy