Kyphoplasty/Vertebroplasty

Overview

Kyphoplasty and vertebroplasty are medical interventions employed to treat vertebral body compression fractures, which are tiny breaks occurring within the dense bone mass comprising the anterior portion of the spinal column, known as the vertebral body. These fractures can lead to the collapse or compression of a vertebra, causing the spine to shorten and curve forward. These conditions often result in pain and a pronounced hunched-over posture known as kyphosis.

Compression fractures are more likely to occur in people who have bones that have been weakened by osteoporosis or pathologic fractures related to spinal tumors.

Vertebroplasty and kyphoplasty share similarities in their approach. Both entail the use of a hollow needle inserted through the back’s skin to access the fractured vertebra. In vertebroplasty, a specialized bone cement, known as polymethylmethacrylate, is introduced through the hollow needle into the fractured bone. In kyphoplasty, a different technique is employed, involving the insertion and inflation of a balloon to restore the compressed vertebra to its normal height before filling the space with bone cement. These procedures are repeated for each affected vertebra. The reinforcement with cement helps restore the vertebra’s strength, enabling an upright posture, alleviating pain, and guarding against future fractures.

If left untreated, the fractures will eventually heal but they will do so in a collapsed condition. Kyphoplasty has the advantage of restoring the vertebra to its normal position before the bone solidifies. Patients who underwent kyphoplasty report much decreased pain following the procedure.

Reasons for undergoing the procedure

People with painful progressive back pain brought on by osteoporotic or pathologic vertebral compression fractures are typically the only ones who benefit from kyphoplasty/vertebroplasty. Candidates for these operations frequently have limited mobility and functional capacity as a result of the fractures.

It is necessary for the patient’s pain to be associated with the vertebral fracture and not to be brought on by other conditions such disk herniation, arthritis, or stenosis (narrowing). To determine whether a vertebral fracture is present, a healthcare provider may request imaging tests including spinal x-rays, bone scans, computed tomography (CT), or magnetic resonance imaging (MRI) scans. A dual energy x-ray absorptiometry (DXA) scan may be prescribed if the patient has osteoporosis.

Both vertebroplasty and kyphoplasty are not suitable for repairing long-standing or chronic fractures, nor do they alleviate back pain resulting from poor posture and forward stooping. In traditional treatment approaches, patients were advised to wait for 4 to 6 weeks to see if their condition improved naturally. However, this waiting period is now believed to lead to the hardening of the bone, reducing the effectiveness of vertebroplasty or kyphoplasty. Due to significantly improved outcomes, many healthcare providers are now recommending vertebroplasty for select patients as early as the first week following a fracture.

Risk

Kyphoplasty and vertebroplasty are associated with minimal risks. Patients have a low likelihood of experiencing complications such as infection, bleeding, heightened back pain, or sensations of tingling and numbness. However, individuals with osteoporosis are at an increased risk of developing additional fractures in other vertebral bodies within the spine.

The healthcare provider will typically ensure that the patient is prescribed medications aimed at improving bone quality to mitigate this risk.

Procedure

Kyphoplasty and vertebroplasty are both considered minimally invasive operations, and they are typically carried out under general or local anesthetic, depending on the healthcare provider’s suggestion and the patient’s needs.

Before the procedure

A healthcare provider may perform the following at a consultation before the procedure:

• Perform a physical examination.
• Discuss about the medical history such as previous surgery, medications, allergies, and recent illnesses.
• Conduct pre-operative test such as blood test, and imaging test.
• Instruct to stop taking any medication such as aspirin, blood thinners, and NSAIDs for seven days before the surgery.
• No food or water intake after midnight before the surgery.
• Avoid wearing jewelry.
• Wear comfortable and loose clothing.

During the procedure

When performing a kyphoplasty or vertebroplasty the patient will be placed on their stomach with cushions supporting their chest and sides after being sedated. Their back or neck will be cleaned and prepared according on which region of the spine the compressed vertebra is in (cervical, thoracic, or lumbar).

The healthcare provider will go through the patient’s skin and into the vertebra using a hollow needle known as a trocar. The surgeon can precisely observe where the needles are placed and how far they have been put using the fluoroscopy monitor.

Following placement of the trocar, the vertebra is either filled with cement (vertebroplasty) or inflated with a balloon-like device (kyphoplasty). As the balloon is inflated during a kyphoplasty, it creates a space so that bone cement may be injected into it. Before the cement hardens, the needles are quickly removed. Skin glue or steri-strips are used to close the minor skin incision. The patient won’t be removed from the surgical table until the last of the cement in the mixing bowl has hardened.

After the procedure

The patient will be transferred to the recovery room. They will have their respiration, heart rate, and blood pressure monitored and their pain will be managed. After the procedure, the patient will lie still for the first hour. They can sit up within an hour. They may get up and move around after two hours. Most patients are observed overnight in the hospital and then discharged the following morning.

After the kyphoplasty/vertebroplasty and when the patient is discharged, the patient will require transportation home. They can resume their regular activities, but for at least six weeks, patient should try to avoid any strenuous activity like heavy lifting.

It could take the patient a few days to experience relief from pain. Within two to three days, any pain brought on by the surgery should be gone.

Maintain the bandage for two days. Instead of bathing, take a shower. Pay attention to any additional advice the healthcare provider may give.

Outcome

Kyphoplasty and vertebroplasty often lead to reduced discomfort and improved mobility within 48 hours after the procedure. While instant pain relief can occur occasionally. Vertebroplasty typically provides pain relief for 75-90% of patients. Most patients are satisfied with the outcomes and can resume their regular activities as before the vertebral fracture.

However, patients should be vigilant for certain signs and symptoms. If their temperature rises above 101.5°F or if there are signs of infection at the incision site, such as redness, swelling, discomfort, or discharge, they should seek immediate medical attention. Additionally, if the patient experiences bowel or bladder issues or has difficulty walking, prompt medical evaluation is necessary.