Spinoplasty

What is Spinoplasty?

Spinoplasty is an image-guided, minimally invasive, surgical therapy used to strengthen a broken vertebra (spinal bone) that has been weakened by osteoporosis or, less commonly, cancer. Spinoplasty can increase the patient's functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. It is usually successful at alleviating the pain caused by a compression fracture. Spinoplasties are often performed on an inpatient basis.

What are some common uses of the procedure?

Spinoplasty is used to treat pain caused by osteoporotic compression fractures. After menopause, women are especially vulnerable to bone loss. More than one-fourth of women over age 65 will develop a vertebral fracture due to osteoporosis. Older people suffering from compression fractures tend to become less mobile, and decreased mobility accelerates bone loss. High doses of pain medication, especially narcotic drugs, further limit functional ability. Spinoplasty is often performed on patients too elderly or frail to tolerate open spinal surgery, or with bones too weak for surgical spinal repair. Patients with vertebral damage due to a malignant tumor may sometimes benefit from spinoplasty utilizing cement. In rare cases, it can be used in younger patients whose osteoporosis is caused by long-term steroid treatment or a metabolic disorder. Typically, spinoplasty is recommended after simpler treatments—such as bed rest, a back brace or pain medication—have been ineffective, or once medications have begun to cause other problems, such as stomach ulcers. Spinoplasty can be performed right away in patients who have severe pain requiring hospitalization or conditions limiting bed rest and medications.

How should I prepare for the procedure?

First, you'll be clinically evaluated. The evaluation generally includes diagnostic imaging, blood tests and a physical exam. Diagnostic imaging such as spine x-rays, a radioisotope bone scan or magnetic resonance (MR) imaging will be done to confirm the presence of a compression fracture that is amenable to spinoplasty. If an MR cannot be performed, because of a pacemaker or other medical factor, a CT scan can be substituted. In preparation for the clinical evaluation and physical exam, you should obtain and bring with you any previous diagnostic images, especially x-rays or MR films. Be sure to tell your doctor if you are allergic to x-ray contrast material, which contains iodine.

Most medical facilities provide patients with pre-procedure instructions. Instructions will typically tell you not to eat for at least six hours before the procedure. If you are diabetic, you should contact your doctor for instructions on regulating your blood sugar and medications. On the day of the procedure, if your doctor instructs you to take your usual medications, swallow your medication with sips of water or clear liquid up to three hours before the procedure. Avoid drinking orange juice, cream and milk.

If you take an anticoagulation medication (blood thinners such as Coumadin), you will have to stop the treatment until coagulation becomes normal, usually within three to five days. Contact your doctor before stopping any medication to determine if it is safe for you. On the day of the procedure, patients who use blood thinners should report to the hospital a little earlier for a blood test to verify that their anticoagulant has stopped working. If you are unable to interrupt your anticoagulant regimen, a short in-patient stay for intravenous treatment with heparin may be required. All patients should arrange for an adult to drive them home after the procedure.

What is OptiMesh?

The OptiMesh implant is a three-dimensional minimally invasive deployable graft containment system. Constructed of Polyethylene Terephthalate yarn, the empty mesh can be inserted into spinal defects through a small cannula and deployed to a large size in situ with granular bone graft.

How does the procedure work?

Spinoplasty is highly effective because after osteoporosis has made bones very porous, the bone graft fills the spaces and strengthens the bone so it is less likely to fracture again. After spinoplasty, the mesh filled bag stabilizes the fracture, which is thought to provide the pain relief. Patients begin regaining mobility within 24 hours and are usually able to reduce, or even eliminate, their pain medication.

How is the procedure performed?

At the beginning of the procedure, the physician will make a very small incision about ¼” long, just to the side of the spine. Next a small guide pin is place into the vertebral body. A dilator is then placed over the guide to pin, to make room for the working cannula to be inserted. When the cannula is in place and the quicktrac is in position, drilling and shaping of the vertebral body is performed. Optimesh is then positioned into the defect and filled with allograft bone. As the mesh fills, the graft tightly compacts, the pores distend and the mesh and graft pack conform to the defect to create intimate graft/bone bed apposition, enabling graft incorporation.

Spinoplasty usually takes less than 45 minutes to be performed (longer if more than one site is being treated).

What will I experience during the procedure?

You'll be lying face down throughout the procedure. Sedation medications will help you stay calm and minimize any discomfort you might feel during the spinoplasty.

For two or three days afterward, you may feel a bit sore at the point of the needle insertion. You can use an icepack to relieve any discomfort but be sure to protect your skin from the ice with a cloth; use the pack for only 15 minutes per hour. The tiny incision will be closed with a strip of tape and covered with a bandage that should remain on for several days. It's important that the injection site remain clean. You can shower while the bandage is still on.

Bed rest is recommended for the first 24 hours following spinoplasty, though you can get up to use the bathroom. Increase your activity gradually and resume all your regular medications. If you take blood thinners, check with your doctor, but you may be able to restart them the day after the procedure.

Who interprets the results and how do I get them?

Most patients are able to bear weight very soon after undergoing spinoplasty. They can get up to walk after resting in bed for about an hour afterward and the interventional radiologist can often tell at that point if the procedure was successful. In some cases, it can take a few days for the doctor to be able to make this assessment.

Usually, patients will receive follow-up phone calls within the first week after spinoplasty to check on their progress and answer any questions. The referring physician or primary care provider provides follow-up care.

What are the benefits?

Benefits

OptiMesh is designed to contain bone graft replacement materials, whereas vertebroplasty and kyphoplasty procedures do not contain the cement.

In lie of bone cement, which has leakage and toxicity complications among the drawbacks, biological bone graft materials can be used to fill OptiMesh.

OptiMesh has the potential to assist in restoring vertebral body height due to bone graft particles which when contained by the mesh, pack together to behave as a strong composite solid.

Because it is less rigid, OptiMesh with bone graft appears to minimize the risk of adjacent level fractures which compared to procedure that utilize bone cement.

OptiMesh with bone graft has the potential to reduce procedure time and radiation exposure for the surgical staff because it is implanted from one side only, and has no curing time.

What are the limitations of Spinoplasty?

Spinoplasty is not used for herniated disks or arthritic back pain.

The procedure cannot serve as a preventive treatment to help patients with osteoporosis avoid future fractures. It is used only to repair a known, non-healing compression fracture.

Spinoplasty will not correct an osteoporosis-induced curvature of the spine, but it may keep the curvature from worsening.

It may be difficult for someone with severe emphysema or other lung disease to lie facedown for a spinoplasty procedure to be performed. The healthcare team will try to make special accommodations for a patient with this type of condition.

Patients with a healed vertebral fracture may not be candidates for spinoplasty.