Augmentation means to add to, vertebral indicates a vertebra, and percutaneous means through the skin. PVA is minimally invasive procedure to augment a vertebra that has fractured because of osteoporosis or injury to the spine. There are two types of PVA: kyphoplasty and vertebroplasty.
Percutaneous vertebroplasty is a relatively new minimally invasive procedure used to treat compression fractures if traditional conservative therapy fails. Vertebroplasty may be able to offer spine stability to patients with spinal fractures caused by osteoporosis and those who have had trauma or tumors of the spine.
After a diagnosis of the compression fracture has been made through an MRI or CT scan, the patient lies prone and is sedated with a mild anesthetic. Under the guidance of an imaging technique called C-arm fluoroscopy, the physician injects a cement-like mixture (polymethylmethacrylate) into the vertebra. The entire process takes one to two hours, although the actual injection usually takes only about 10 minutes. The cement mixture hardens in about half an hour and after a short recovery period the patient is sent home. Pain killers are often given to the patient for the first couple of days to help ease the pain.
Percutaneous vertebroplasty may be preferred to open surgery for osteoporosis patients because of the already brittle bone. However, percutaneous vertebroplasty will not correct the bone lost due to by osteoporosis; it may only stabilize new fractures. The procedure may restore lost height and decrease “widow’s hump.”
Although the long-term prognosis may not be good for patients with spinal tumors, percutaneous vertebroplasty can be used for spine stabilization to improve their quality of life, pain relief and ability to function.
Percutaneous vertebroplasty is relatively new and long-term results are not known. Patients who have one vertebral fracture are five times more likely to get another adjacent to the damaged one; therefore steps should be taken to limit the effects of osteoporosis. Although complications appear to be less than 1%, percutaneous vertebroplasty can cause infection, bleeding or embolism if the cement mixture gets into the blood stream and passes through the heart and lungs. Please discuss with your physician whether vertebroplasty is an appropriate medical option for you.
Generally, osteoporotic fractures of the spine result in a collapsing of the front portion of the vertebrae causing it to compact into a wedge shape, thus causing pain, a loss of height and a hunched-over appearance (called “dowager’s hump” or “widow’s hump”.)
Kyphoplasty uses a two-step process of inserting of a special balloon device into the compacted vertebrae to attempt to restore the vertebrae to a more normal shape. Subsequently, a cement-like material (polymethylmethacrylate) is injected into the space created by the balloon to retain the correction. By restoring the vertebrae to a more normal state, alignment of the spine may be improved.
Kyphoplasty is performed through a small incision in the back. It is done in a hospital setting under either a local or general anesthetic, depending upon the severity of the case. The entire procedure takes about an hour for each treated vertebrae and patients may return home the day of surgery, or perhaps stay in the hospital overnight. Pain relief may be seen within two days of surgery.
Kyphoplasty is a new therapy and long-term results are not known, nor are the effects of the therapy on the surrounding vertebrae. As with all medical procedures, kyphoplasty does have risks that should be discussed with your physician prior to considering treatment.
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