When should the spinal bone subsidence be treated with bio-cement pump?

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Vu Huy Hoang - Radiologist - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International General Hospital.

Bio-cement pump is a new method in the treatment of spinal depression with many advantages such as pain-free patients immediately after being injected with cement. After 1-2 hours, the patient can walk and eat normally.

1. What is spinal depression?

Spondylolisthesis is a condition in which the spinal discs lose water and flexibility, leading to collapse and damage to the patient's spine. There are many causes of spinal depression such as osteoporosis, spinal trauma, vertebral body tumors, multiple myeloma, etc. In which, osteoporosis is the most common cause. It is estimated that out of 100 million people with osteoporosis, about 3 million people have spinal depression, more than one-third of which become chronic pain. The incidence of vertebral collapse increases with age, the disease occurs in 25% of female patients over 50 years old and 40% in 80-85 years old male patients. People who have experienced vertebral collapse due to osteoporosis are five times more likely to have a second collapse than those who have never had it.
Deterioration of the vertebrae causes prolonged pain, reduces mobility, all activities and labor of the patient will be very difficult. In addition to local pain, patients may experience intercostal neuralgia, spinal deformity,... The disease has a very high potential for disability, severely affecting the patient's quality of life.

2.When to treat spinal depression with bio-cement?

Treatment of spinal bone subsidence with bio-cement pump is a method of using a very small catheter to poke through the skin and inject bio-cement into the collapsed vertebrae. Treatment with this bio-cement pump is applied in the following cases:
Spine subsidence due to causes such as osteoporosis; injury; Malignant tumors, due to prolonged use of corticosteroids,... Patients with spinal depression were treated with pain relievers, back brace, rest,... but it was not effective. Acute spinal pain caused by spinal depression requires hospitalization for treatment. Spondylolisthesis in the elderly.

3. How is the treatment of spinal subsidence with bio-cement pump performed?

3.1. Preparing the patient before treatment with bio-cement pump To prepare for treatment with bio-cement pump, the patient will be thoroughly examined by a doctor, assigned to perform a number of imaging techniques and blood tests to assess the general health status and the degree of bone settlement in the spine.
Patients need to inform the doctor about their medical history, the drugs they are using, including supplements. In particular, it is important to notify if you are allergic to local anesthetics or contrast agents, are pregnant or suspect that you may be pregnant.
The doctor may ask the patient to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), anticoagulants for some time before the procedure.
3.2. Prepare equipment to inject bio-cement to treat spinal subsidence The necessary equipment to perform bio-cement pump treatment of spinal subsidence includes:
Polymethylmethacrylate bio-cement (PMMA), When injected into the damaged area, the bio-cement will solidify

Hollow needle or tube (called troca) Ball to create a space in the vertebral body to inject cement. The X-ray machine connects to a video screen for the doctor to monitor the procedure, ensuring that the bio-cement is injected into the correct position of the collapsed vertebrae. In addition, equipment such as ultrasound machine, heart rate monitor and blood pressure monitor, ... are needed to monitor the patient's general condition during the procedure.
3.3. How is the bio-cement pump to treat spinal subsidence performed? Pumping bio-cement includes two methods: pumping bio-cement with balls and pumping bio-cement without balls. In which, the bio-cement pump with the ball is prioritized due to its high safety index, the doctor is active in shaping the vertebrae and the amount of cement put into the vertebral body. However, the downside is the higher cost. Pumping bio-cement for basic spinal depression treatment is performed as follows:
The patient is instructed to lie prone on the table to perform the procedure. The implementation team installs equipment to monitor blood pressure, heart rate, breathing rate; Place an intravenous line to deliver medication if needed.

Nursing for the patient will be able to use some drugs prescribed by the doctor such as sedatives, antiemetics, antibiotics to prevent infection,... The doctor will disinfect and numb the area where the needle is inserted. location closest to the injury. Then, a small incision is made in the skin, under the guidance of the intervention machine, the needle is poked through the muscles of the spine to the damaged area. In the technique of pumping bio-cement without the ball (Vertebroplasty), bio-cement will be injected from the outside through the needle into the vertebrae, about 20 minutes the cement may be liquid but then the cement will harden, the spine fixed. In the technique of bio-cement injection (Kyphoplasty), the doctor uses a balloon to pass through the needle lumen into the damaged vertebral body, then inflate the balloon to bring the vertebral body to normal height. Next, the balloon will deflate slowly and be brought out. The space in the vertebral body created by the ball will be filled with bio-cement. After bio-cement has been injected, X-ray film or computerized tomography is taken to check the distribution of cement. Bandage to stop bleeding and remove the intravenous line. The technique of bio-cement injection in the treatment of spinal depression is usually performed in about an hour or so if the patient has many damaged vertebrae. Bio-cement pump is considered a big step forward in the treatment of spinal depression. Patients who are treated with this technique usually have no pain right after being injected with cement. About 1-2 hours after the procedure, the patient can walk and eat normally. Bio-cement pump treatment of spinal depression is especially effective for elderly patients or those with combined cardiovascular and respiratory diseases.
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