After adequate vertebral filling has been achieved, the needle is removed. Occasionally, venous bleeding is experienced at the needle entry site. Hemostasis is easily achieved with local pressure for 5 minutes. The entry site is dressed with Betadine ointment and a sterile bandage. The patient is maintained recumbent for 1 to 2 hours after the procedure and monitored for changes in neurological function or for signs of any other clinical change or side effects. (Table 14.2 lists typical postoperative orders.)
Any sign of adverse events should trigger the use of appropriate imaging modalities (usually CT) in the search for an explanatory cause. It is well known that 1 to 2% of patients will have a transient period of benign increase in local pain following PV. However, this is a diagnosis of exclusion and should prompt extended monitoring (or hospi-talization if the pain is severe and requires aggressive therapy) and imaging evaluation to exclude other causes for the pain (such as cement
Figure 14.12. (A) Anterior-posterior radiograph showing a good bipedicular vertebral fill of bone cement. (B) Lateral radiograph show the same vertebra. Note that the entire central volume of the vertebra is not filled.
Table 14.2. Sample postoperative orders and discharge instructions
Bed rest 1 hour (may roll side to side).
Vital signs and neurological examinations (focused on the lower extremities) every 15 minutes for the first hour, then every 30 minutes for the second hour.
Record pain level (Visual Analog Scale, 1-10) at end of procedure and at 2 hours postoperatively (before discharge). Compare with baseline values and notify physician if pain increases above baseline.
May have liquids by mouth if no nausea.
Discontinue oxygen (if used) after procedure (if saturation is normal).
Discontinue intravenous drips after 1 hour if recovery is otherwise uneventful.
Discharge patient home with adult companion after 2 hours if recovery is uneventful._
Return home; bed rest or minimal activity for next 24 hours.
May resume regular diet and medications.
Keep operative site covered for 24 hours. Bandages may then be removed and site washed with a damp cloth. Do not soak.
Notify physician or facility if there is increasing pain, redness, swelling, or drainage from the operative site.
Notify physician or facility if there is difficulty with walking, changes in sensation in hips or legs, new pain, or problems with bowel or bladder function.
The area of the procedure will be tender to the touch for 24 to 48 hours. This is to be expected.
If there is pain similar to that before the procedure, prescribed pain medications may be continued as needed._
extravasation). Pain alone will usually be adequately treated with analgesics, nonsteroidal anti-inflammatory drugs (such as Toradol), or local steroid injections adjacent to affected nerve roots or in the epidural space. Large cement leaks (Figure 14.13) or neurological dysfunction should prompt an immediate surgical consultation.
PV is easily performed on an outpatient basis with the patient discharged after 1 to 2 hours of uneventful recovery. (Table 14.2 gives typical discharge instructions.) Follow-up is indicated to monitor the results of therapy and should be incorporated into a quality management program. Reports of complications and results should be maintained by the facility as well as for each individual provider. Additional information and recommendations about the credentialing and quality management for PV can be found in the American College of Radiology manual on standards of practice.
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