Spinal Implant Procedure for Compression Fractures (Vertebral Implant)
What You Need to Know
- A spinal implant is a new type of spine cement augmentation procedure that is approved by the Food and Drug Administration for osteoporosis-related compression fractures in the spine.
- Spinal compression fractures cause back pain, height loss and abnormal curvature of the spine.
Why would you need a spinal implant?
VCFs occur when the vertebral body — the oval segment of the bone that forms the front of the vertebra — in the spine collapses. Often, VCFs are a result of osteoporosis or they can happen after tumors develop in the spine (pathologic compression fractures). Spinal implant procedures treat VCFs.
Osteoporosis can cause the bones of the spine to become thin and weak. The bones then easily compress and break, resulting in spinal collapse and loss of height. If this happens in multiple levels in the spine, pronounced spinal curvature may develop. VCFs can occur from simple daily activities and can cause significant pain and mobility impairment.
About the Spinal Implant Procedure
A spinal implant is an outpatient procedure that is performed by a spine neuro-interventional radiologist. Interventional neuroradiologists are radiologists who specialize in the diagnosis and treatment of abnormalities of the brain, spine, and head and neck.
During a spinal implant procedure, a very small titanium device that looks like the jack for a car is inserted into the spine. The implant is expanded within the collapsed vertebra to gain back the lost height, and it can almost restore the height of the compressed vertebra back to prefracture levels. The implant also helps correct alignment of the spine. Once the implant is placed correctly, special medical bone cement is added, which holds the implant and the fracture repair in place.
A spinal implant procedure can restore a patient’s vertebral height and significantly reduce the pain associated with acutely or subacutely compressed vertebrae. Height restoration achieved with this procedure also reduces the incidence of future adjacent-level spinal fractures (fractures that occur next to the primary fracture).
Patients should be able to resume normal activities 72 hours after the procedure.
Johns Hopkins Interventional Neuroradiology
Our interventional neuroradiologists are among the first in the nation to be trained and to perform spinal implant surgery. We strive to provide the finest in patient care through the compassionate application of cutting-edge techniques.
Spinal Implant Procedure | Ed's Story
(uplifting piano music) >> We were actually looking for a house down the road.
And we drove by here, and I made this dumb mistake of stopping and getting a pamphlet.
And we made the offer on the house, and it was accepted.
And um, moved in and I said, "Well if we're gonna be here," very active, "we need to be doing stuff." And, so I thought I was going to just work on the farm.
We were going to get cattle, and um, shortly after we moved in, I started having back issues.
And that's where everything started.
All right, Bill, we gotta pick up some rocks, okay?
Come on down.
>> Ed: I couldn't get out of my truck, and I had to have somebody come in, go over plans him and tell him what I needed him to do, and that was very frustrating.
>> He would hold on to his >> Belt loops.
>> Yeah, like this.
So that the front of him wouldn't move.
>> A back doctor did take a look at me, and he sent me to a pain management doctor.
He looked at everything and he said, "You need a bone density test." I had the test done, and I was in the changing room.
I went down to tie my shoe and I cracked a rib.
>> When I saw Ed first time in the clinic, uh, he was in severe pain.
And we scanned him, did an MRI and a CT of his spine, and we found that he had at least 6 to 7 compression fractures of his spine.
So that's when we decided that we will take care of Ed by doing what's called the vertebral implant or some people just call it a vertebral stent.
>> By looking at the MRIs and X-rays, and CAT scans, he diagnosed that I had at least 9 vertebrae that needed to be corrected.
I explained how they were little jacks that they used to um, separate the vertebrae.
And they would put a bone cement in between em, to support them.
>> This is the stent and, this is this is completely deployed right now.
So the endplate of the vertebras would be right here.
And if I would be happy with this position, then we will be starting to put cement in, and there are two side holes in the central bar.
And that's where the cement comes out and fills up the central portion of the implant, and anchors the implant within the vertebra.
Ed had about 6 or 7 fractures, and we do 3 levels in one sitting.
So, I picked his worst 3 levels which were giving him the most pain, and we treated those 3 levels, and we put uh, implants in 2 of them.
Which was where the fulcrum of his curve was, so that we could, we could actually restore some height so that it could straighten up his spine a little bit.
Only few places offer this uh, treatment all over the country and Hopkins is one of the premier sites for this.
>> Do you want more?
>> (babbles) >> Yes or no?
>> I saw him the second or third day after I had done the procedure.
I was so glad to see him walking straight with his back up, without somebody holding him.
It's amazing when you see that your patients feel so much better within a few days of the procedure.
That's what we strive for, and that's what we really want.
That makes your day, that makes your week, that makes your month.
>> If you think about it, in the middle of May we had a hospital bed in our family room.
We had a walker.
We had a cane.
You were hardly getting around, and you've been so fine since your third surgery that you can do all the stuff that you were doing before.
Now I'm at the point now, where, you know, I feel confident with the grandkids.
The kids pick up rocks and right, and it's all because of the back surgery, and uh, now I can make them have a little bit of a work ethic, which is something that I really try to instill into our kids.
You lose your independence, and you start getting your independence back.
It's a great feeling.
Image above (left to right) During procedure; before implant, with implant deployed; after with implant/Cement.
What to Expect Before, During and After a Spinal Implant Procedure
Before the procedure:
- Your doctor will likely order an X-ray, take a complete medical history, and do a physical exam to determine the precise location and nature of your vertebra-related pain. The doctor might also use magnetic resonance imaging (MRI) or a computed tomography scan (CT or CAT scan).
- Tell your doctor about all prescription and over-the-counter medications and any herbal supplements you are taking.
- Tell your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin or other medications that affect blood clotting.
During the procedure, your neuroradiologist:
- Gives you sedation medication or general anesthesia, depending on the pain and your ability to lie still during the procedure
- Uses a continuous X-ray to guide the needle into the fractured vertebra, with your body protected from the radiation
- Slowly introduces the spinal implants into your fractured vertebral body via two small 1 centimeter skin incisions and then injects cement into the vertebra under X-ray guidance
After the procedure:
- You will lie on your back for a short amount of time while the cement hardens.
- You will remain in an observation room for an additional three to four hours for monitoring.
- You may experience pain relief almost immediately after the procedure, or it may take up to 72 hours. Your doctor can provide pain relief medications for the temporary discomfort.
- Your doctor will assess your pain and check for any possible complications before you are discharged to go home.
- You may need to continue wearing a back brace, but it’s usually not necessary.
- You will come back for a follow-up appointment and imaging in three to four weeks.
Spinal Implant Procedure Risks
There is very low risk involved in a spinal implant procedure, but complications that can happen include:
- Increased back pain
- Tingling, numbness or weakness because of nerve damage (rare)
- Cement leaking out of position during the procedure (rare)
You may face other risks, depending on your specific medical condition. Make sure to discuss any concerns with your doctor before the procedure