Episode 33 – Vertebroplasty

Watch the video version of this Q&A episode on YouTube – https://youtu.be/8wHLTmat6Cs 

During a patient interview, a physical therapist discovers that a patient is two weeks post vertebroplasty. This procedure was MOST likely performed for which of the following medical conditions?

1. Disk herniation
2. Compression fracture
3. Spinal instability
4. Spondylolysis

Welcome back to the Scorebuilders’ Q and A Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

During a patient interview, a physical therapist discovers that a patient is two weeks post vertebroplasty. This procedure was MOST likely performed for which of the following medical conditions?

1. Disk herniation
2. Compression fracture
3. Spinal instability
4. Spondylolysis

Vertebroplasty
Vertebroplasty is a minimally invasive procedure used to stabilize vertebral compression fractures, most often caused by osteoporosis. 

The surgeon uses a fluoroscope to locate the fractured vertebra and injects specialized bone cement into the fracture site. The cement hardens and quickly seals the fracture, reducing pain and improving mobility. A similar procedure to vertebroplasty is kyphoplasty. 

Kyphoplasty uses special balloons to restore lost vertebral height and the space created within the vertebra is then filled with bone cement.

Let’s explore each of the options:

Option 1 - Disk herniation
Disk herniations most commonly occur on the posterolateral portion of the disk where it is weakest and most likely to fissure. 

When the disk herniates, it often will compress nearby nerve roots and cause pain, numbness, and/or weakness into the extremities. 

Conservative treatment is successful in the large majority of patients. If conservative treatment is unsuccessful, a cortisone injection may be necessary. A small percentage of patients will eventually need surgery (i.e., microdiscectomy).

Option 2  - Compression fracture
Osteoporosis leads to thin and porous bones that fracture easily and result in direct and indirect complications. A patient with osteoporosis may complain of thoracic or lumbar pain and experience compression fractures of the vertebrae.

Physical therapy should include an exercise program that emphasizes weight bearing activities as tolerated. 

Vertebroplasty and kyphoplasty are minimally invasive procedures that can stabilize compression fractures in the spine, relieve pain, reduce the use of pain medication, and improve mobility.

Option 3 - Spinal instability
Spinal instability refers to excessive movement between two vertebral segments (i.e., hypermobility). Instability often develops when a particular disk and/or facet joint degenerates to the point that the affected segment can no longer support the weight of the body.

Spinal fusion is the procedure performed to prevent any movement between the vertebrae and stabilize the involved segment to prevent damage to adjacent neural tissues.

Option 4 - Spondylolysis
Spondylolysis is a stress fracture through the pars interarticularis of the vertebral arch (i.e., pars defect), usually at the L4-L5 or L5-S1 levels. Although spondylolysis can occur in individuals of all ages, children and adolescents who participate in sport activities are most susceptible because their spines are still developing. 

The vast majority of patients with spondylolysis can be managed with conservative treatment. However, if the spondylolysis progresses to a forward slippage of one vertebra on the vertebra below (i.e., spondylolisthesis) to a degree that causes significant neurological impairment, surgical intervention involving decompression with or without spinal fusion may be necessary.

The correct answer is Option 2 

Let’s explore the all student data:
8% of students selected Option 1, Disk herniation
64% of students selected Option 2, Compression fracture - the correct response
12% of students selected Option 3, Spinal instability
16% of students selected Option 4, Spondylolysis

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!