Vertebroplasty for hemangiomas and compression fractures

- a minimally invasive intervention performed to strengthen or restore the vertebrae using
bone cement
.
As a rule, mature and elderly patients who have suffered osteoporosis or compression fractures turn to a neurosurgeon for spinal surgery. After vertebroplasty, the spine becomes more flexible, and after a few days the patient’s pain completely disappears. This method refers to minimally invasive puncture interventions
.
This means that such an operation eliminates difficult long-term rehabilitation, as well as the need for general anesthesia. Thus, a significant advantage of vertebroplasty is the high efficiency of the technique and minimal risks. For patients with compression fractures of the spine
,
aggressive hemangiomas
, as well as diseased joints and thinned bones due to
osteoporosis
, this treatment option is the most favorable.

The cost of vertebroplasty for hemangiomas and compression fractures of the spine depends on the characteristics of the clinical picture of the degenerative disease, the clinic and the specialist performing the operation.

If, based on MRI results, you have been diagnosed with a compression fracture, hemangioma, intervertebral hernia, stenosis

or another clinically significant disease, and you do not know what to do next, then you can
free
recommendations from a neurosurgeon.
To do this, simply upload the images through a special form on this page of the website
- the doctor will give recommendations on treatment tactics. The patient does not always require spinal surgery; sometimes surgery can be replaced by interventional pain treatment.

How is the procedure done?

During the operation, medical cement is injected into the spine with a needle. The procedure is performed under x-ray guidance and is considered minimally invasive as the work is performed through a small puncture in the skin. There is no open incision. The mandatory requirement is to administer the substance within six minutes. The entire operation takes about an hour and is performed under local anesthesia. After the cement has hardened, the patient can go home. If there is a risk of complications, observation for two days in the hospital is possible.

Hardened bone cement:

• Strengthens the damaged area;
• Eliminates pain;
• Restores back functions.

The procedure is carried out in areas where the vertebral body is covered only by skin and access to them is not difficult. Hence the name of the operation - percutaneous vertebroplasty . Due to the absence of large traumatic incisions, and access to the vertebrae through punctures and needles, the operation has a second name - puncture vertebroplasty .

Approximate cost of surgical intervention to strengthen the vertebrae

Not all medical institutions have the necessary equipment for performing vertebroplasty, as its cost is quite high. Also, the complexity of carrying out operations in government institutions free of charge is made difficult due to insufficient qualifications of specialists. Therefore, in most cases, surgical intervention to strengthen the vertebral bodies is carried out in private medical centers .

Vertebroplasty is an expensive procedure. Before you trust an unfamiliar specialist, make sure of his competence and high qualifications, find out about the number of operations he has performed and their outcomes. Pay attention to the quality of service in the medical facility itself and make sure that the necessary equipment is available.

On average, the cost of vertebroplasty on 1 segment of the spinal column can range from 30,000 to 70,000 rubles , depending on the degree of damage to the vertebra.

The indicated amount for the operation does not yet include the costs of the material used by the neurosurgeon.

In this case, a preoperative consultation with a neurosurgeon can cost 4000-5000 rubles. The use of local anesthesia will cost the patient approximately 1,000 rubles, and a day of hospital stay costs from 5,000 to 7,000 rubles.

Indications and contraindications

Spinal vertebroplasty is performed for spinal hemangioma in the acute stage, when the patient experiences discomfort when exposed to physical activity. The degree of aggressiveness is determined by the intensity of pain and the structure of the vertebrae (detected by CT and MRI).

Vertebral hemangioma can develop asymptomatically for a long time, and is detected by chance when a person consults a doctor due to severe pain. Such education requires a serious approach and a decision on the advisability of surgical treatment. The most modern technique is hemangioma vertebroplasty. As a rule, rehabilitation proceeds without complications and takes no more than 3 weeks. It is impossible to prevent the growth of spinal hemangioma, especially if there is an existing predisposition, but you can avoid excessive stress and injury.

The main indication for surgery is pain in the area of ​​injury.

There is a need for surgery if there is a risk of fracture. In case of metastatic lesions, the introduction of bone cement has a cytotoxic effect. Effective vertebroplasty is possible provided that the vertebral body is destroyed by no more than 70%.

Absolute contraindications are:

• Inflammation of the bone tissue of the vertebra;
• Blood clotting disorder;
• Asymptomatic vertebral body fracture;
• Allergic reactions.

Relative contraindications:

• Systemic infection;
• Myelopathy or radiculopathy;
• Severe narrowing of the central canal.

Indications for the use of vertebroplasty

Surgical intervention to strengthen the vertebral bodies is used in cases:

• 
  Surgical treatment is prescribed if there is a risk of a compression fracture. The patient has hemangiomas (vertebral angiomas) - hemangiomas are benign tumors. They can affect most of the vertebral body and provoke pain in the spine during physical activity and even when walking. The location of pain is the part of the spinal column in which the vertebrae are damaged.

• Active progression of osteoporosis - this disease is characterized by a violation of the bone structure of the components of the skeleton due to metabolic disorders in the body. Osteoporosis leads to disruption of the microarchitecture of bones, including the vertebrae.
• Back injuries resulting in the patient receiving compression fractures of the vertebrae (fall, road accident).
• The presence of metastases in the patient’s spine (can occur with breast cancer, lung cancer).

Note! Vertebroplasty provides the desired positive result in 90% of cases.

Rehabilitation after surgery

Recovery after surgery occurs in a short time, unless it was preceded by a spinal fracture. In this case, recovery from injury will be required.

During the first 24 hours after vertebroplasty, bed rest is recommended. Normal activities are resuming gradually. Pain at the puncture site is relieved by applying cold.

Over the next two days, the pain decreases and soon the person returns to normal life.

Vertebroplasty is used for compression therapy of the spine. In this case, the patient is given an antibiotic for prophylaxis. After the procedure you need to lie down for two hours. For osteoporosis, the procedure promotes recovery.

After surgery, the patient is required to:

• If necessary, wear a corset;
• Treat the underlying disease to avoid recurrence of the injury;
• Do not stand or sit for a long time;
• If pain occurs, take a horizontal position;
• Walk only until pain appears;
• Avoid carrying and lifting heavy objects;
• Perform therapeutic exercises.

What is bone cement for vertebroplasty?

In order to fuse a weak vertebra, restore its shape, give it reliable rigidity and eliminate pain, a kind of polymethyl methacrylate drug (PMMA) is used for orthopedic purposes. In medicine, it is called bone cement, the price of which is high, which explains the high cost of the treatment procedure. The drug is represented by two main components: a liquid monomer and a powdery polymer. They are combined using a special mixer immediately before the puncture.

Cement.

When two substances are mixed, a polymerization reaction occurs, accompanied by the release of heat for 8-10 minutes. Without exceeding this time threshold, the neurosurgeon specifically introduces the resulting mass (55° Celsius), which resembles a semi-liquid paste, into the problem segment. The cementing composition permeates the spongy bone tissue, filling all defects from the inside and connecting the separated bone fragments into a single whole. What happens to the cement after the time is up? After about 10 minutes, it will harden into an impenetrable solid conglomerate that can withstand pressure of as much as 100 Pa. Thus, the restored segment also receives powerful prevention from the occurrence of fractures in the future.

For VP, special types of non-toxic cement are used, which have the following characteristics:

• high viscosity, which ensures uniform filling of bone tissue with cement mortar and prevents it from leaking beyond the vertebra;
• optimized thermal effect, thereby eliminating the likelihood of burn damage to anatomical structures;
• excellent biocompatibility with biological bone structures, which does not allow the body to react negatively to the substance introduced into the spongy tissue and trigger a rejection reaction;
• radiopacity, in other words, clear visualization of the drug during its implantation, which ensures high control over the process of injection of bone cement;
• antibacterial qualities due to the optimal content of antibiotics in the composition of the drug, which prevents the development of infectious and inflammatory processes;
• impeccable biomechanical properties, while sufficient strength, even of a very fragile element with severe osteoporosis, is achieved after the introduction of only 3.5-4.0 ml of cement.

Tecres product line.

As you may have noticed, polymethyl methacrylate is additionally enriched with a radiopaque additive and an antibiotic agent. As a rule, barium sulfate (BaSO4) acts as a contrast agent. The antibiotic is gentamicin or vancomycin.

Risks and complications

Risks include:

• Extrusion of cement solution, which provokes compression of nerves;
• Blood clot formation;
• Pulmonary embolism.

Practice shows that in most cases complications are associated with diseases of the spine:

• Oncological nature;
• Vertebral hemangioma;
• Osteoporosis.

Vertebroplasty is a safe operation, the successful outcome is close to 100%.

But complications are still possible in some cases (up to 5%).

Infection, tingling, severe soreness, and paralysis may occur.

• The main complication is the injection of too much cement, which causes compression of the nerve tissue, causing pain. In this case, the intervention is repeated and excess cement is removed.
• Infection due to poor hygiene. The likelihood of such a complication is almost zero, since the incision is small.
• Allergic reaction. Before the operation, tests are done for medications and bone cement.
• Lack of positive dynamics. In this case, the patient is given a thorough examination and the cause is determined.

Neurosurgery 2005.1

R.S.Dzhindzhikhadze*, V.A.Lazarev**, A.V.Gorozhanin**, A.N.Borzunov*, I.I.Tsuladze**

**Department of Neurosurgery of the Russian Medical Academy of Postgraduate Education (head of the department - Prof. O.N. Dreval)

* State Clinical Hospital named after. S.P. Botkin (chief physician, prof. - V.N. Yakovlev), Moscow

Percutaneous vertebroplasty (PVP) is a minimally invasive radiological procedure that involves percutaneous injection of bone cement (polymethyl methacrylate, PMMA) into the damaged vertebral body [17,35].

For several decades, vertebroplasty has been used as an open surgical procedure in which bone cement is injected to strengthen the vertebral bodies before the installation of stabilizing systems. Some surgeons have used the procedure to fill the empty space after tumor resection [3,17,26].

The first PVP procedure was performed in 1984 by Galibert and Deramond in the Department of Radiology of the University Hospital of Amiens, France, on a 54-year-old woman for an aggressive C2 vertebral hemangioma [19]. Later, PVP was performed for vertebral osteolytic metastases and secondary collapse of the vertebral body due to osteoporosis [5,27].

Biomechanical justifications.

Many retro- and prospective studies indicate a significant regression of pain symptoms in approximately 90% of cases with osteoporotic compression fractures [13,23] and in 70-75% in patients with various tumor pathologies [9,54]. From the moment of the first procedure to Currently, the most frequently mentioned factors for reducing, and sometimes completely relieving, pain are: thermal, chemical and mechanical [12,17,31,50,54].

A. Thermal factor - most likely caused by thermal necrosis of nerve endings, as a result of an exothermic polymerization reaction. Thermal necrosis of osteoblasts occurs at temperatures above 50°C for more than 1 minute, whereas apoptosis of osteoblasts occurs at temperatures of 48°C for 10 minutes or more. In addition, increased temperature may play a role in significantly reducing the growth rate of tumor cells [15,30,31,32].

B. The chemical factor is due to the cytotoxic effect of PMMA. The cytotoxicity of the monomer also determines the antitumor effect, which is confirmed by numerous clinical data [6,49,50].

C. The mechanical factor is the most basic reason for reducing pain by stabilizing and strengthening the vertebral body, preventing micromovements in the fracture area and thereby reducing irritation of nerve endings [36,43,50].

In case of tumor damage, perhaps, in addition to the above mechanisms, a significant role is played by the ischemic factor, caused by an increase in hydrostatic pressure in the vertebral body due to the mechanical displacement of tumor tissue by bone cement within the limits of osteolytic activity [36].

Indications for PVP.

I. Vertebral tumors (benign tumors (aggressive hemangiomas); metastatic lesions of the spine (osteolytic metastases, multiple myeloma)) [6,11,17,18,36,40];

II. Compression fractures of the vertebral bodies due to osteoporosis, accompanied by pain [11,17,36,39,46,50];

III. Rare indications (Kümmel disease, lymphoma with an osteolytic component, fibrous dysplasia, eosinophilic granuloma) [11,18,19,21,38].

Percutaneous vertebroplasty technique (method of implementation).

Standard studies before the PVP procedure:

Examination, including a detailed examination of the neurological status, X-ray examination of the spine in two projections, CT preferably with 3D reconstruction, MRI to exclude compression of the spinal cord structures and/or roots, general clinical tests and a detailed coagulogram. Patients with suspected metastatic lesions of the spine, in addition to the above examination methods, should undergo an oncological search.

Preoperative administration of antibiotics. The most commonly used is cefazolin 1 g intravenously or intramuscularly. As an alternative, it is possible to use oral antibiotics (ciprofloxacin 500 mg 2 times a day) [37,53].

Anesthesia. Anesthetic management includes neuroleptanalgesia and local anesthesia with a 1% lidocaine solution in layers according to the future route of the needle [11,17,36]. In patients with a high degree of pain, as well as when the lesion is localized at the level of the cervical spine, it is more advisable to use general anesthesia [4,36].

Insertion and positioning of the needle. The entire procedure is performed under fluoroscopic or CT control [11,17,20,25]. The insertion and positioning of the needle into the vertebral body depends on the level and extent of the vertebral lesion. In this regard, there are several approaches to the affected vertebrae: transpedicular, parapedicular (transcostovertebral), posterolateral, anterolateral and transoral (for access to the cervical vertebrae).

The classic approach for most of these procedures at the lumbar and thoracic level is transpedicular; posterolateral access is less commonly used. The needle is inserted to the border of the anterior and middle thirds of the vertebral body (2/3 of the distance from the posterior wall and 1/3 from the anterior wall of the vertebral body) [17,36].

Phlebospondylography. It is the second important stage of percutaneous vertebroplasty. Phlebospondylography allows assessment of venous drainages at the level of interest, but cannot be more likely to predict cement leakage during the procedure due to the different viscosity of the contrast agent and bone cement [17].

The injection of bone cement is the final step. The amount of cement injected ranges from 2 to 8 ml per level. Barr et al report that an injection of 2 - 3 ml at the thoracic level and 3 - 5 ml at the lumbar level causes pain regression in 97% [4,36,50].

Postoperative regimen. For an hour after the procedure, bed rest must be observed, and an examination is required every 15 minutes, including assessment of vital functions and neurological status [36]. During this period, PMMA reaches 90% of its maximum rigidity [22]. If there are no complications after PVP, then after 1 hour the patient can be allowed to sit up in bed with the help of an assistant. A follow-up CT (preferably helical CT) of the treated level should be performed after the procedure to visualize the extent of the implant. As a rule, in the first hours after the procedure there is a regression of the pain syndrome by almost 50%, but an increase in pain is also possible. In this case, the use of analgesics and non-steroidal anti-inflammatory drugs for 1 to 2 days is indicated [17,36].

Complications.

Occurs in 1 - 10% of cases
.
During the procedure, complications include cement leakage, which is more common when there is significant destruction of the endplates and posterior vertebral body. In case of vertebral hemangioma and compression fracture against the background of osteoporosis, the risk of clinically manifested complications does not exceed 1%; for patients with metastatic tumors this figure is no more than 5–10%, which is largely due to both the patient population and the nature of vertebral destruction [17 ,36].

1. Spondylitis as a manifestation of infectious complications after PVP. The above-mentioned complication occurs quite rarely, usually in patients with immunodeficiency [11,36,41].

2. Transient increase in pain and increase in body temperature. It occurs infrequently and is largely associated with manipulation during the procedure. [6,10,11,36].

3. Transient hypotension during bone cement injection [53].

4. Fracture of a rib, transverse process, vertebral arch, pleural injury [17,18,23,41,53].

5. Radiculopathy. Associated with leakage of bone cement into the radicular vein or intervertebral foramen. In most cases, radiculopathy resolves while taking oral NSAIDs. Surgical intervention involving cement removal and root decompression is rarely required [4,11,17,36,47].

6. Spinal cord compression is also a rare complication. Occurs more often with metastatic lesions of the vertebra. In most cases, open surgery is required [11,17,36].

7. Pulmonary embolism. It can be caused by the use of excess amounts of bone cement, for example, during cementation of a large number of vertebrae and/or penetration of cement into the paravertebral veins [2,11,17].

8. Hemorrhage. Occurs in patients with coagulopathy. Given this circumstance, coagulopathy should be corrected before performing vertebroplasty [36].

9. Fatal outcome. The literature describes cases of deaths that were associated with a large number of vertebrae undergoing cementation. It is generally accepted that no more than three vertebrae be treated during one procedure [36].

Contraindications

.

1. Any manifestations of a local (osteomyelitis, epidural abscess) or general (sepsis) infectious process [36].

2. Coagulopathy (platelets less than 100,000, prothrombin time 3 times higher than the upper limit of normal, partial thromboplastin time 1.5 times higher than normal) [36,54].

3. Compression of the spinal cord with the development of secondary myelopathy [12,17,54].

4. Allergic intolerance to the components of polymethyl methacrylate [11].

5. Compression fractures with a decrease in body height of more than 70% (“vertebra plana”) are technically difficult when performing PVP [17,36,54].

Radiculopathy and destruction of the posterior wall of the vertebral body are not absolute contraindications for performing PVP, although the risk of complications increases significantly. In this situation, the patient should be warned about the possible negative consequences of the procedure [11,36].

Metastatic lesion of the spine.

In patients with various forms of cancer, metastatic lesions of the spine occur in 27–70% of cases according to various authors [4]. It ranks third after the lungs and liver [44]. The lumbar region in general is more often affected by metastases [45]. Among all spinal tumors, approximately 96% are metastases. The remaining 1-4% are primary benign and malignant tumors [48]. The vertebral body is most often affected [34].

Osteolytic metastases and multiple myeloma most often affect the spine. Patients in this category are often plagued by severe pain, and as a result, a decrease in motor activity.

According to foreign authors [8,34], breast cancer (30%), prostate cancer (25%), and lung cancer (10%) are the leading causes of metastatic lesions of the spine. After diagnosis - metastatic bone lesions - 83% of prostate cancer patients and about 78% of breast cancer patients die within the first year. 22% of lung cancer patients die within the first year after the appearance of vertebral metastases. Survival in patients with hypernephroid cancer and thyroid cancer depends on the histology of the tumor [51,52].

As a rule, metastases in the spine in patients with lung cancer are detected within a period of 3.6 to 6.1 months; in patients with breast cancer, this period is 29.4-33.5 months. Knowledge of these data is necessary for planning PVP in the above-mentioned category of patients [24].

Patients with severe localized back pain associated with minor physical activity, limiting the patient’s activity and provoking the use of narcotic analgesics are the most basic indications for PVP in patients with vertebral metastases. PVP is often indicated for patients with a short life expectancy who are contraindicated for open surgery [17,27,54].

Vertebral hemangioma. (VG)

Hemangioma belongs to vascular tumors and, according to various authors, occurs in 1-1.2% of cases among all bone tumors [16]. According to pathological studies, its frequency is 10.7% [28]. Hemangiomas occur in any part of the spine, mainly in the thoracic, then in the lumbar, and extremely rarely in the cervical and sacral [16]. Most often one vertebra is affected. The average age of patients is about 40 years, with a predominance of women in the proportion of 3:2. The tumor most often affects the vertebral body, but can spread to the arch [28].

In most cases, VH are asymptomatic and are detected incidentally during X-ray or neuroimaging studies. Rarely, hemangiomas can cause pain with or without a pathological fracture. The aggressiveness of hemangiomas can be identified by clinical signs and/or radiological findings [36].

The most common symptom is severe, localized pain. Palpation and percussion of the paravertebral region and the spinous process are usually painful [36].

Neurological signs of aggressive or potentially aggressive VH are described by Laredo et al.: localization between Th3 - Th9 vertebrae, damage to the entire vertebral body, expansion of the cortical layer with unclear edges, irregular honeycomb-like cellularity of hemangiomas, the presence of a soft tissue component in the epidural space. Other radiological signs of aggressiveness of hemangiomas include: increase in size on control X-ray examination, risk of pathological fracture [29,36].

According to clinical and radiological manifestations, CH is divided into four groups [17,36]:

1. Asymptomatic hemangiomas without radiological signs of aggressiveness (identified by chance).

2. Symptomatic (painful) hemangiomas without radiological signs of aggressiveness.

3. Asymptomatic hemangiomas with radiological signs of aggressiveness (identified by chance).

4. Symptomatic VH with radiological signs of aggressiveness are, in turn, divided into VH with epidural spread and VH without epidural spread.

Indications for PVP are based on the above classification. For patients in group 1, the PVP procedure is not indicated. For patients of group 2, the procedure is indicated for pain relief. In this group of patients, the indications become more justified when VH is localized in the thoracic spine. For patients of group 3, PVP is indicated in case of clinical symptoms. Percutaneous vertebroplasty is indicated for all patients of group 4. For patients with acute myelopathy or cauda equina syndrome, open surgery in combination with PVP is indicated. It should be noted that, despite the generally accepted contraindications to PVP, in patients with spinal cord compression, percutaneous injection of bone cement before surgery is indicated as the first stage in order to stabilize the vertebral body and reduce the risk of massive intraoperative bleeding [36].

Compression fractures of the vertebral body due to osteoporosis

.

Fractures due to osteoporosis represent a huge medical and socio-economic problem. In the United States alone, there are more than 1.5 million osteoporotic fractures annually, of which 700,000 are vertebral fractures. There is a strong relationship with the age of the patients. The incidence of osteoporosis in women increases by 15% in the age group of 50-59 years and by more than 70% in those over 80 years of age [50].

Most vertebral fractures due to osteoporosis occur spontaneously (46%) or after minimal trauma (36%), but the correct diagnosis is made at the first visit to the doctor only in 43% of cases [42]. More often, a compression fracture due to osteoporosis manifests itself as acute back pain. Complications of an osteoporotic vertebral body fracture include prolonged pain in the area of ​​the fracture and the development of kyphotic deformity. Compression fractures due to osteoporosis can significantly worsen the patient’s quality of life and cause activity limitation, severe pain, insomnia, and depression.

Compression fractures while taking glucocorticosteroids are the most common manifestation of secondary osteoporosis. More than 50% of patients taking steroid drugs experience compression fractures. The risk of fracture is dose-dependent, usually increases during the first month of hormonal therapy and remains elevated throughout the course [33].

Traditionally, conservative treatment of osteoporotic fractures has included bed rest, analgesics, and bracing. However, such therapy did not bring the desired results and, in addition, led to secondary complications in the form of worsening osteoporosis, pneumonia, deep vein thrombosis of the legs, and embolism of the branches of the pulmonary artery [50].

Percutaneous vertebroplasty has proven itself as a procedure that provides rapid regression of pain syndrome in localized pain associated with the level of compression fracture in 70 - 95% of patients [14,46].

Percutaneous vertebroplasty is a minimally invasive procedure that provides rapid regression of pain and mechanical strengthening of the vertebral body in most patients. PVP is the method of choice in the treatment of pain in patients with metastatic lesions of the spine, aggressive vertebral hemangiomas, compression fractures of the vertebral bodies due to osteoporosis.

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Where is vertebroplasty performed?

For an effective operation, it is important to choose the right clinic and surgeon. Many patients choose the Central Clinical Hospital of the Russian Academy of Sciences in Moscow. Here, the best specialists – experienced neurosurgeons, who have the latest equipment at their disposal – restore the health of the spine.

You can find out more about the work of the clinic, the cost of diagnostics and treatment of the spine on the website; reviews of patients who have undergone surgery are also provided here. Many of them note that after vertebroplasty, the pain syndrome has decreased significantly and significant relief is felt.

Vertebroplasty is a sought-after procedure that is currently gaining popularity.

Patients in need of vertebroplasty can find out how much the operation costs by calling the clinic's telephone numbers.

Vertebroplasty: cost and quality analysis

Most often, osteoporotic fractures occur in the lower thoracic and lumbar (lumbar) spine, especially in elements T11, T12, L1, L2. Hemangiomas are found mostly in the thoracic area. Therefore, it is these anatomical objects that mainly need cementoplasty. The approximate cost of the operation is about 100 thousand rubles. However, everything depends on the characteristics of the diagnosis and the complexity of the case, the price of consumables, the number of defective segments and, of course, the skill level of the surgeon.

In Moscow, in some hospitals, according to our monitoring, the price sometimes reaches up to 150,000 rubles. Somewhere away from the capital, take Chelyabinsk as an example, the procedure costs an average of 85,000 rubles. As evidenced by reviews from patients who have undergone such spine treatment in our country, our cost does not always mean what the quality will be. This statement, of course, does not apply to all hospitals, but, unfortunately, there are a small number of worthy ones.

Another problem is that it is not always possible to find a clinic in your city. You have to undergo unsafe surgical intervention or limit yourself to unjustified conservative therapy, that is, the minimum that municipal medical institutions have. There is another option: travel to another city or, if it is important for a person to receive impeccable medical care, go abroad. The Krasnoyarsk residents were unlucky in this case. People are ready to accept any cost, but in Krasnoyarsk, in fact, it is impossible to undergo such an operation anywhere.

We also do not organize rehabilitation for such patients well enough, and everywhere. It is worth noting that, despite the low degree of surgical trauma, the operated person necessarily needs high-quality restoration of the spine, and the restoration program must be very thoroughly thought out. In Russian medical institutions, the patient undergoes physical rehabilitation at great expense, but does not receive proper care. Or it doesn’t go away at all. This leads to frequent complications and an additional “bouquet” of problems.

In fact, after this intervention, the risk of developing consequences should not exceed 1%-2%; in Russia it is increased to 4%-7%. This fact is explained by the fact that for the domestic territory this surgical technology is still a new, insufficiently mastered and practiced treatment tactic. Needless to say, we have a shortage of truly first-class specialists with a narrow focus, dedicated to their work and responsible to each patient. But the price in St. Petersburg and the main capital for the corresponding type of therapy is considerable. Therefore, many people choose foreign medical services.

Today, the country where all the tactics of minimally invasive spinal surgery are mastered is the Czech Republic. Prices here will be approximately 2 times lower than in any other prosperous state, and the quality will be the same, if not better. Why? Each surgical treatment program in Czech clinics necessarily includes full rehabilitation; this is a mandatory condition that operates at the legislative level in this country. The leader in demand and quality of services offered is the leading medical company Artusmed.

Among the Russian medical institutions that enjoy a good reputation, of course, within the Russian Federation, we can highlight the Research Institute named after. Vreden and DKB JSC Russian Railways (St. Petersburg), National Medical and Chemical Center named after. Pirogov and the Research Institute of Traumatology and Orthopedics named after Priorov (Moscow).

Pain Management Clinic Specialists

Shapoval Nikolay Sergeevich Neurologist, Pain Treatment Specialist

Experience: more than 8 years

Details Make an appointment Call a doctor Online consultation

Sinelnikov Konstantin Andreevich Neurologist, Specialist in pain treatment

Experience: more than 10 years

Details Make an appointment Online consultation

Chernenko Valery Yurievich Neurologist, Specialist in pain treatment

Experience: more than 7 years

Details Make an appointment Call a doctor Online consultation

Tyulikov Konstantin Vladimirovich Neurosurgeon, Specialist in pain treatment, Doctor of the highest category, Candidate of Medical Sciences

Experience: more than 14 years

Details Make an appointment

Galperin Mark Yakovlevich Pain treatment specialist at the E. Malysheva clinic, anesthesiologist, algologist

Experience: more than 25 years

Details Make an appointment

Shubin Dmitry Nikolaevich Neurologist, chiropractor, Pain Treatment Specialist at the E. Malysheva Clinic

Experience: more than 30 years

Details Make an appointment

Trushin Pavel Vadimovich Neurosurgeon, Candidate of Medical Sciences

Experience: more than 10 years

Details Make an appointment

Ivanyuk Andrey Genrikhovich Neurologist, reflexologist, doctor of the highest category

Experience: more than 26 years

Details Make an appointment

Percutaneous vertebroplasty: stages of the operation

During the operation, a puncture technique is used to create access for the introduction of medical cement. For stabilization, there is no need to install any internal metal fixators at all, which are not biodegradable implants. And this fact is an undeniable advantage of vertebroplasty.

32 years have passed since the creation of the method, so it can be safely called a proven and guaranteed effective method of augmenting partial and weak vertebrae. The intraoperative process takes place on an outpatient basis under local anesthesia; in some cases, it is additionally possible to administer intravenous sedatives for the patient’s psycho-emotional comfort.

1. During the surgical session, the person lies on his stomach. To avoid neuropathic consequences, the operating doctor places cushions under certain parts of the body.
2. The skin is extensively treated with an antiseptic, after which the doctor makes the correct anatomical markings on the skin. It is needed so that you can accurately introduce the anesthetic agent and correctly insert the puncture needle, through which, in fact, the strengthening solution will be supplied.
3. Next, infiltration anesthesia is injected into the tissues of the surgical field, which will have a strong analgesic effect, and the patient will not experience any discomfort during surgery.
4. Then, under powerful intraoperative fluorographic control, a thin needle is inserted parapendicularly or transpedicularly along its entire length into the affected vertebra. When the high-precision insertion of the needle is completed, the specialist begins preparing the cement mortar.
5. After mixing the PMMA well, the resulting creamy mass is immersed in a special piston, which is connected to a conductor needle. Then the viscous mixture is immediately squeezed into the intravertebral structures in strictly dosed quantities.
6. At the end of the manipulations, the instruments are carefully removed, and the wound is disinfected, and a sterile bandage is attached over it. Sutures are not required, since such a miniature puncture (size is approximately 3 mm) heals safely on its own without suture tying the edges of the skin. The entire session takes 40-50 minutes.

After 10 minutes, the introduced mixture completely hardens. As a result, the once defective segment acquires correct proportions, integrity and strength. The operated person does not get up immediately; he needs to maintain a horizontal, motionless position for another 2 hours. Afterwards you are allowed to get up and move around. If the condition is satisfactory, the patient is usually sent home on the same day (after approximately 6 hours). If the specialist considers it necessary not to rush into discharge, you may be hospitalized for 2-3 days.

Important! In most cases, the use of support devices in the form of corsets and bandages is not necessary. A person can walk normally immediately. However, do not neglect an orthopedic device if your doctor prescribed it for you! Remember that the complexity of the clinical picture is different for everyone, and on an individual basis it is possible that for your adequate recovery you will need to wear a certain type of fixation belt.

Surgical treatment of diseases and injuries of the spine

At SM-Clinic, surgical operations are performed to treat the following lesions of the spine and spinal cord:
Degenerative lesions of the spine and intervertebral discs

• herniated intervertebral discs,
• spondyloarthritis
• degenerative spinal canal stenoses,
• spondylolisthesis
• complex vertebrogenic pain syndromes

Tumors of the spine, spinal cord, nerve roots
Consequences of traumatic injuries to the spine and spinal cord

Vertebroplasty for spinal hemangioma

The unique medical service provided for progressive hemangiomas has also attracted numerous reviews and questions. Each medical forum contains many requests addressed to those who have undergone a similar intervention for such a diagnosis. Future patients are concerned not only with the price, but also with what features of the operation for an ill-fated vascular neoplasm, and what effect should be expected after it. Well, in order to make it easier for you to find information on the merits, we will briefly and clearly cover all these vital aspects.

Computer tomogram.

For small asymptomatic hemangiomas of the cavernous and capillary types, treatment is not required; only periodic hemodynamic monitoring is necessary. If a tumor measuring 1 cm or more is detected or the pathology causes painful symptoms, then surgery is necessary. Intervention in such a situation is necessary not only to eliminate painful phenomena, but also to prevent destruction of the vertebrae and damage to the spinal cord. The leading method for a serious diagnosis today is transcutaneous VP. Its cost varies in the range of 90-110 thousand Russian rubles. In foreign European countries ≈ 9000-20000 euros.

• The technical features of treating benign formations are the same as in the case of osteoporosis. Under high-tech radiographic control, a cementing substance is injected into the tumor cavity, which is localized inside the bone body.
• Rapid pain relief occurs due to a cytotoxic (chemical) effect, as well as thermal effects on nerve endings. The cytotoxic properties of the administered composite also have antitumor capabilities, which makes it possible to suppress the growth of pathological cells and achieve regression of the disease.
• The analgesic effect is also determined by the strengthening and stabilization of the vertebra, which eliminates the excited state (irritation) of the nerve endings.

During the procedure.

Numerous studies show that the bloodless procedure provides significant relief in the early postoperative period in more than 85% of cases. The remaining patients note gradual improvement throughout the entire recovery phase. The risk of complications is low, but greater than after manipulations associated simply with compression fractures or osteoporosis; the percentage is 2%-5%.