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Physiotherapy in Sidneyfor Mid BackIntroduction

Welcome to Sidney Physiotherapy'spatient resource aboutVertebroplasty.

Patients with osteoporosis are prone to

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compression fractures in the spine bones,or vertebrae. The front of a vertebracracks under pressure, causing it tocollapse in height. More than 700,000such fractures occur every year in theUnited States. These fractures oftencause poor back posture, debilitatingpain, and difficulty completing routineactivities.

Vertebroplasty restores the strength ofthe fractured bone, thereby reducingpain. More than 80 percent of patientsget immediate relief of pain with thisprocedure.

This guide will help youunderstand:

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why the procedure becomes necessarywhat surgeons hope to achieve withvertebroplastywhat to expect during recovery

Anatomy

What parts of the spine areinvolved?

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The main section of each spine vertebra isa large, round block of bone called avertebral body. Compression fracturescause this section of bone to collapse. Thecollapsed vertebra gives the spine ahunched appearance, called kyphosis,and the loss of vertebral height shortensthe muscles on each side of the spine.This forces the back muscles to workharder, causing muscle fatigue and pain.The vertebral body is the main structuretreated in the vertebroplasty procedure.

Compression Fractures

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Related Document: SidneyPhysiotherapy's Guide to Thoracic SpineAnatomy

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Rationale

What do surgeons hope to achieve?

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In the past, surgeons used standard opensurgery to fix compression fractures fromosteoporosis. Open surgery requireslarger incisions to give the surgeon moreroom to operate. The results of opensurgery for this condition have generallybeen poor, mainly because it is difficult todo surgery on bones that are weak andsoft from osteoporosis. In addition, someaging adults with fractures may not bephysically able to tolerate such surgery.

Vertebroplasty gives surgeons a way to fixthe broken bone without the problemsassociated with open surgery. Unlikeopen surgery, vertebroplasty is aminimally invasive procedure. Itrequires small openings in the skin and

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small instruments. This lessens thechance of bleeding, infection, and injuryto muscles and tissues.

Surgeons fix the bone in place bysqueezing special cement into the brokenbone. The cement strengthens andstiffens the vertebra, which reduces painconsiderably and helps the patient returnto normal activities.

This procedure doesn't restore theoriginal height of the broken vertebra,however. Nor does it prevent thekyphosis (hunchback) deformity thatsometimes results from compressionfractures.

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Preparations

How will I prepare for theprocedure?

The decision to proceed withvertebroplasty must be made jointly byyou and your surgeon. You shouldunderstand as much about the procedureas possible. If you have concerns orquestions, talk to your surgeon.

Vertebroplasty is normally done on anoutpatient basis, meaning patients gohome the same day as the surgery. Youshouldn't eat or drink anything aftermidnight the night before.

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Surgical Procedure

What happens during theprocedure?

The patient lies on his or her stomach. Tobegin, the surgeon cleans the skin on theback with an antiseptic. Then the skinand muscles over the problem area arenumbed using an anesthetic. Patientsmay also receive general anesthesia toput them to sleep during the procedure.

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A small incision is made in the skin oneach side of the spinal column. A longneedle is inserted through each opening.The surgeon slides the needles throughthe back of the spinal column into thefractured vertebral body.

A fluoroscope is used to guide theneedles. This is a special X-ray televisioncamera adjusted above the patient's back

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that lets the surgeon see the patient'sspine on a screen. Metal objects show upclearly on X-rays. The needles are easyfor the surgeon to see on the fluoroscopescreen. This helps the surgeon confirmthat the needles reach the correct spot.

Once the needle is in place, special bonecement, called polymethylmethacrylate(PMMA), is injected through the needleinto the fractured vertebra.

A chemical reaction in the cement causesit to harden in about 15 minutes. Thisfixes the bone so it can heal. Bandagesare placed over the small openings wherethe needles were inserted.

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Complications

What might go wrong?

Serious complications fromvertebroplasty are rare, involving lessthan five percent of cases. As with otherprocedures, however, complications canoccur. Some of the most commoncomplications of vertebroplasty include

problems with anesthesiathrombophlebitisinfectioncement leakageongoing pain

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This is not intended to be a complete listof possible complications.

Problems with Anesthesia

Problems can arise when the anesthesiagiven during surgery causes a reactionwith other drugs the patient is taking. Inrare cases, a patient may have problemswith the anesthesia itself. In addition,anesthesia can affect lung functionbecause the lungs don't expand as wellwhile a person is under anesthesia. Besure to discuss the risks and yourconcerns with your anesthesiologist.

Thrombophlebitis (Blood Clots)

Thrombophlebitis, sometimes called deep

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venous thrombosis (DVT), can occurafter any operation. It occurs when theblood in the large veins of the leg formsblood clots. This may cause the leg toswell and become warm to the touch andpainful. If the blood clots in the veinsbreak apart, they can travel to the lung,where they lodge in the capillaries andcut off the blood supply to a portion ofthe lung. This is called a pulmonaryembolism. (Pulmonary means lung, andembolism refers to a fragment ofsomething traveling through the vascularsystem.) Most surgeons take preventingDVT very seriously. There are many waysto reduce the risk of DVT, but probablythe most effective is getting you movingas soon as possible. Two other commonly

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used preventative measures include

pressure stockings to keep the blood inthe legs movingmedications that thin the blood andprevent blood clots from forming

Infection

Infection following spine procedures israre but can be a very seriouscomplication. Some infections may showup early, within the first few days afterthe procedure. Infections on the skin'ssurface usually go away with antibiotics.Deeper infections that spread into thebones and soft tissues of the spine areharder to treat. They may require surgery

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to treat the infected portion of the spine.

Cement Leakage

The cement used in vertebroplasty is in aliquid form and is squeezed into thefractured vertebra under high pressure.Some of the cement commonly leaks outof the vertebra, but this usually doesn'tcause any problems. Only rarely does acement leak cause pressure on the spinalcord or nearby nerves. In these cases,surgery may be required to remove thepressure.

Ongoing Pain

Many patients get nearly complete reliefof symptoms from vertebroplasty. As

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with any procedure, however, you shouldexpect some pain afterward. If the paincontinues or becomes unbearable, talk toyour doctor about treatments that canhelp control your pain.

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After Surgery

What happens after surgery?

Patients are monitored in the recoveryroom for two to three hours after theprocedure before going home. Patientsare instructed to move their backs onlycarefully and comfortably. Some patientswho feel extra pain or other problemsafter the procedure may need to stay in

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the hospital overnight.

Patients rarely need to wear a brace aftervertebroplasty, since bone cementimmediately improves the strength andstiffness of the fractured vertebra.

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Our Rehabilitation

What should I expect as I recover?

People often report greater ease withdaily activities within a week aftervertebroplasty. Pain also decreasesrapidly, and most people require less painmedication within two weeks. Despitethese quick improvements, most

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orthopedists consider that it takes aboutthree months for the bone to heal aftervertebroplasty.

Patients are encouraged to walk and domoderate activity as they recover.However, patients should avoidstrenuous activity until the surgeonapproves it.

Patients who continue to have pain orwho have lost muscle tone and strengthmay need to undergo physiotherapy. AtSidney Physiotherapy, ourphysiotherapists can design apersonalized program to help speed yourrecovery. Although each individualrecovers at their own pace, our

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vertebroplasty patients typically attendtherapy sessions for four to six weeks.

When the original fracture was due toosteoporosis, our physiotherapist willsuggest ways to prevent future problems.Patients may advised on dietarysupplements (calcium and vitamin D) tomaximize bone health and lifestylechanges, such as quitting smoking andstarting an exercise program, may also bediscussed.

The goal of our physiotherapy is to safelyadvance strength and function. Ourphysiotherapist may use treatments suchas heat or ice, electrical stimulation, ormassage to calm pain. Gentle exercise

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improves the strength of the spine andlimbs. We can help you learn how tomove safely using healthy postures toreduce strain on the healing back.Exercises for the heart and lungs improvestamina and help with pain control.

As your physiotherapy sessions at SidneyPhysiotherapy come to an end, we will

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help you get back to the activities youenjoy. Ideally, our patients are able toresume normal activities. Ourphysiotherapist may councel you onwhich activities are safe or how to changethe way you go about your activities.

When recovery is well under way, yourregular visits to Sidney Physiotherapywill end. Although we will continue to bea resource, you will eventually be incharge of doing your exercises as part ofan ongoing home program.

Sidney Physiotherapy provides servicesfor physiotherapy in Sidney.

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