What is a Kyphoplasty/Vertebroplasty?
Kyphoplasty/vertebroplasty are common, minimally-invasive techniques for a vertebral compression fracture (VCF). A VCF is a broken vertebral spinal bone that has decreased in height due to a fracture, causing back pain. Both procedures inject cement into the fractured vertebra, which provides support and strength to the damaged area.
Vertebroplasty has been performed since the 1990s, and kyphoplasty is a newer variant of vertebroplasty that has some added benefits. These procedures are very successful at providing pain relief for patients suffering from a VCF when conventional treatments have proved ineffective.
What does it treat?
A compression fracture, or VCF, occurs when vertebrae in the spine are compressed and collapse, fracturing the bone. Abnormal spinal curvatures may occur as a result of multiple compression fractures, such as kyphosis, which is a hump-like curvature of the spine.
Osteoporosis is the most common cause of a compression factor (osteoporotic compression fracture). However, tumors and trauma and previous fractures can all cause a VCF. Though kyphoplasty treats the compression fracture and pain caused by the compression fracture, it does not treat the underlying cause, which must also be addressed.
If a cancerous tumor is the cause of the fracture, radiation therapy as well as surgery to remove some of the bone and treat the tumor may be required. If a traumatic injury is the cause of the fracture, a fusion surgery may be required to repair the bone and join the vertebrae together.
Who is a candidate?
Patients with the following conditions are optimal candidates for kyphoplasty:
- Osteoporotic VCFs in any area of the spine present for more than two weeks that are unresponsive to conservative therapy and causing moderate to severe pain
- Painful tumor metastases and multiple myelomas
- Painful vertebral hemangiomas (benign, malformed vascular tumors)
- Vertebral osteonecrosis (bone death due to poor blood supply)
- Reinforcement of a weak vertebra before a surgical stabilization procedure, such as a fusion
To be a candidate for a kyphoplasty/vertebroplasty, a patient’s pain must be related only to the vertebral fracture. The pain must not be due to other conditions, such as arthritis, disk herniation, or vertebral stenosis (narrowing of the spinal canal). Imaging tests are usually ordered during diagnosis of a compression fracture to rule out these other conditions.
Although a large percentage of patients report significant pain relief after vertebroplasty and kyphoplasty procedures, there is no guarantee that surgery will help all patients. Not all patients are candidates for surgical treatment, and there are many criteria that may bar a patient from undergoing surgery.
What are the advantages of Kyphoplasty/Vertebroplasty?
Kyphoplasty is a newer procedure and has the added benefit of restoring some height to the spine. It is minimally invasive, meaning a quicker recovery and little to no down time. Most patients report significant pain relief and improved mobility after the surgery – usually within 48 hours. In some cases, immediate pain relief is reported.
How is it performed?
Vertebroplasty is usually done as an outpatient surgery, though may require an overnight hospital stay. It takes from one to two hours depending on the number of vertebrae being treated.
- Local anesthetic and intravenous sedation or general anesthesia are used, though general anesthesia is primarily used.
- X-ray guidance is used to insert a small needle into the collapsed vertebra.
- A specially formulated acrylic bone cement is injected and hardens in minutes, strengthening and stabilizing the fractured vertebra.
In a kyphoplasty versus vertebroplasty procedure, two balloons are added before cement is injected into the vertebra. Mechanical support and stability provided by the bone cement are thought to relieve pain.
- Two small incisions are made. The incisions are so small that stitches are usually not required.
- A probe is placed into the space where the fracture is located.
- The vertebra is drilled and a small balloon (bone tamp) is inserted on each side of the bone.
- The balloons are inflated with contrast medium (using x-ray image guidance) until they expand to the desired height.
- The two balloons are removed.
- The spaces created by the balloons are filled with kyphoplasty cement.
Kyphoplasty recovery time is very quick. Most patients go home the same day as their surgery, though some may need an overnight hospital stay. There may be soreness where the needle entered the back. Ice and pain medication can help relieve the soreness, which usually abates within a few days. Many patients are able to start walking as soon as an hour after the procedure, and also notice less pain than was present before the surgery. The surgeon should approve all activities and indicate activities to avoid after the procedure.
Lifting heavy objects for the first 24 hours after surgery should be avoided. Diet may resume as normal. Over-the-counter pain medications may be taken as needed for soreness.
Certain vitamins, minerals and medications may be suggested or prescribed to help strengthen the bones and prevent additional spinal fractures. Immediate compression fracture treatment is essential to relieving the pain and complication risks of the compression fracture. However, prevention of subsequent fractures is just as important. Bone-strengthening drugs (bisphosphonates) may be prescribed to help stop and/or restore bone loss.
The majority of patients are able to return to all normal activities performed prior to the vertebral compression fracture.