What are Vertebroplasty & Nerve Blocks?
Vertebroplasty and image-guided Nerve Blocks are two complementary interventional radiology procedures that provide precise, targeted pain relief for patients living with debilitating spinal pain. In vertebroplasty, medical-grade bone cement is injected through a needle directly into a fractured vertebra under fluoroscopic guidance, instantly stabilising the collapsed bone and dramatically relieving the pain that can make even breathing difficult. In kyphoplasty an advanced variant a balloon is first inflated inside the vertebra to partially restore its height before cement is injected, reducing spinal deformity.
Image-guided nerve blocks involve injecting a carefully chosen mixture of local anaesthetic and corticosteroid precisely around a specific nerve root, facet joint, epidural space, or nerve plexus under real-time fluoroscopy or CT guidance. By interrupting pain signals at their exact source and reducing localised inflammation, nerve blocks provide relief that lasts weeks to months far longer and more targeted than oral medication alone enabling patients to engage in physiotherapy and rehabilitation that would otherwise be impossible.
Who is this procedure for?
Vertebroplasty is indicated for patients with painful vertebral compression fractures caused by osteoporosis, multiple myeloma, or spinal metastases, where conservative management with analgesia, rest, and bracing has failed to control pain adequately after 4–6 weeks, or where the pain is so severe that the patient is bedbound. Image-guided nerve blocks are recommended for patients with chronic radicular pain (sciatica from a prolapsed disc), lumbar or cervical facet joint arthropathy, sacroiliac joint dysfunction, post-herpetic neuralgia affecting the spine, or cancer-related spinal pain particularly those who have not obtained sufficient relief from oral medications or who wish to reduce their dependence on opioid analgesics.
How is the procedure performed?
- Pre-procedure MRI or CT confirms the level and characteristics of the vertebral fracture (for vertebroplasty) or identifies the precise pain generator nerve root, facet joint, or sacroiliac joint to be targeted (for nerve blocks).
- The patient lies face down (prone) on the procedure table; the skin overlying the target vertebra or nerve is thoroughly cleaned and numbed with local anaesthetic.
- For vertebroplasty: under continuous fluoroscopic (X-ray) guidance, a specialised bone biopsy needle is advanced through the pedicle of the fractured vertebra into the vertebral body using a transpedicular approach.
- High-viscosity bone cement (PMMA) is slowly injected under real-time fluoroscopic monitoring the position and spread of cement are watched constantly to ensure it fills the fracture safely and does not leak toward the spinal canal.
- For nerve blocks: a needle is advanced under fluoroscopy or CT guidance to the target anatomical location nerve root foramen, facet joint, epidural space, or sacroiliac joint and correct position is confirmed with a small injection of contrast dye.
- The therapeutic solution (local anaesthetic plus corticosteroid, or phenol for longer-acting neurolytic blocks in cancer pain) is injected precisely at the target site; the needle is removed and a small dressing applied.
- The patient is observed for 1–2 hours before discharge; pain relief from vertebroplasty is often felt within 24–48 hours, while nerve block relief typically begins within the first few days as the steroid takes full effect.
