Advantages over open surgery
Traditional open spine surgeries carry significant risks. Approximately 20–30% of patients develop the so-called failed back surgery syndrome (FBSS). In contrast, percutaneous discectomy (percutaneous discectomy) and discolysis (discolysis) demonstrate high reliability in treating radiculopathy and disc herniations.
Main advantages of the percutaneous approach:
- The procedure is safe and performed as a day-case surgery (day case).
- The risk of postoperative scar tissue formation is minimized.
- Sustained improvement in quality of life.
Special attention should be given to intradiscal ozone injection. Ozone discolysis involves injecting an oxygen-ozone gas mixture directly into the nucleus pulposus under fluoroscopic guidance. This technique is used to treat radiculopathy associated with posterolateral disc prolapse (increased radiolucency of the disc is noted after the injection).
Percutaneous vertebral augmentation
Interventional radiology is not limited to disc procedures; it also includes percutaneous vertebral augmentation (percutaneous vertebral augmentation). This is a set of procedures aimed at stabilizing vertebrae (and, in some cases, pelvic bones) in pathological fractures and bone insufficiency.
Main augmentation techniques:
- Cementoplasty (cementoplasty) is the basic percutaneous injection of radiopaque cement to consolidate bone under fluoroscopic guidance.
- Vertebroplasty, kyphoplasty, and osteoplasty are procedures focusing on restoring the original vertebral height.
- Sacroplasty (sacroplasty) is similar reinforcement of the sacral structures.
The goal of these interventions is to prevent new fractures and relieve debilitating pain in osteolytic lesions.
Causes of fractures and patient selection criteria
The diagnostic criterion for a non-traumatic compression fracture is a decrease in the height of an individual vertebral body by more than 20% or 4 mm. The most common cause of such conditions is osteoporosis (affecting more than 10 million people). Neoplastic processes take second place: spinal metastases, multiple myeloma (multiple myeloma), and lymphoma.
Procedures are indicated exclusively when conservative therapy fails:
- In osteoporosis: inability to control pain (even with massive opioid doses) for at least 3 weeks.
- In metastases: refractory pain despite adequate oncological treatment and radiation therapy.
The ideal candidate for vertebroplasty is a patient who presents 3 to 6 weeks after the fracture without signs of improvement.
Indications and contraindications for cementoplasty
Augmentation is used for osteoporotic compression fractures, painful osteolytic lesions, sacral and acetabular fractures. Specific indications include aggressive vertebral hemangiomas and giant cell tumors (the goal is tumor devascularization and consolidation of the lesion). If the tumor extends epidurally, cementoplasty serves as an adjuvant to sclerotherapy. The list of indications also includes acute burst fractures, osteonecrosis, Langerhans cell histiocytosis, and the vacuum phenomenon (vacuum phenomena).
Absolute contraindications:
- Spinal cord compression (spinal cord compression).
- Positive response to medical therapy.
- Uncorrectable coagulopathy.
- Osteomyelitis, discitis, or active systemic infection.
- Presence of more than 5 or diffuse bone metastases.
- Allergy to bone cement.
- Lack of available neurosurgical support.
Briefly: answers to topical questions
What is the technical difference between vertebroplasty and kyphoplasty?
The main technical difference is the use of a special inflatable balloon in kyphoplasty to create a cavity and restore vertebral height before cement injection.
| Characteristic | Vertebroplasty (Vertebroplasty) | Balloon kyphoplasty (Balloon kyphoplasty) |
|---|---|---|
| Cavity preparation | Not performed, cement is injected directly into the vertebral body | An inflatable balloon is used before cement injection |
| Goal | Pain relief and stabilization | Fracture decompression, cavity creation, and partial restoration of vertebral body height |
What complications can occur after percutaneous intervertebral disc decompression?
After percutaneous intervertebral disc decompression, complications are rare—occurring in 0.25–0.7% of cases. They include:
- infectious discitis;
- epidural hematoma;
- vascular or nerve injury.
What is failed back surgery syndrome (FBSS) and what are its main causes?
Failed back surgery syndrome is a specific clinical nosology characterized by the persistence or onset of lower back pain and neurological symptoms following surgery for degenerative conditions.
Main causes of the syndrome:
- Preoperative factors — misidentification of the pain source and psychosocial factors (depression, anxiety, secondary gain).
- Postoperative stenosis (Postoperative Stenosis) — causes pain in 25–29% of patients due to accelerated degenerative changes.
- Postoperative synovial cysts (Postoperative synovial cysts) — a rare cause of the syndrome.
What types of bone cement are used in cementoplasty and vertebroplasty?
Polymethylmethacrylate (PMMA) is used in cementoplasty and vertebroplasty. During preparation, its viscosity increases from liquid to paste-like, and polymerization is accompanied by heat generation. The cement is radiopaque; once hardened, it remains in the vertebra permanently, providing ongoing structural support.
Class and exam questions
It is performed on an outpatient basis, minimizes the risk of scar tissue formation, and helps avoid severe failed back surgery syndrome, the risk of which reaches 20–30% with open surgery.
The intervention provides reliable pain relief and is performed on an outpatient basis with a minimal risk of scar tissue formation. This helps avoid failed back surgery syndrome, the risk of which reaches 20–30% with open surgery.
How soon will the result of the disc intervention be visible on MRI?
Morphological changes on CT or MRI, such as a decrease in herniation size, become noticeable only a few months after the procedure.
What is the purpose of ozone discolysis?
The procedure is used to treat radiculopathy associated with posterolateral disc prolapse. An oxygen-ozone mixture is injected into the nucleus pulposus, which subsequently increases the radiolucency of the disc.
What else to study on this topic
- Mechanism of action of the oxygen-ozone mixture on the nucleus pulposus tissue.
- Differential diagnosis of non-traumatic compression fractures of the vertebrae (osteoporosis vs. oncology).
- Specific aspects of kyphoplasty performance and the biomechanics of vertebral height restoration.
- Application of cementoplasty as adjuvant therapy in aggressive hemangiomas.
Master the entire topic in the "Diagnostic Radiology" course
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Other topics in the "Interventional radiology" section
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