Kyphoplasty and Vertebroplasty

Kyphoplasty and vertebroplasty are minimally invasive procedures used to treat vertebral compression vertebral compression fracturefractures (VCFs) of the spine. These fractures cause pain and limit mobility of the spine.

VCFs are related to osteoporosis, traumatic injury, and spinal tumors. Close to a million vertebral compression fractures occur annually in the US, so it is a prominent problem.

What happens with a vertebral compression fracture?

When the patient sustains a VCF, the body of the vertebra collapses into itself, producing a wedged vertebra. Once several vertebrae collapse, the patient develops a humped spine (kyphosis).

Patients with osteoporosis have weakened bones, which makes them at risk for compression fractures, and any activity can cause a fracture, including lifting, sneezing, or coughing. A VCF causes severe back pain, reduced mobility, loss of independence, and problems with sleep.

How are kyphoplasty and vertebroplasty performed?

The kyphoplasty and vertebroplasty procedures are similar, and both involve insertion of a small needle through the skin and into the fractured vertebra. In vertebroplasty, bone cement is injected into the fractured area through a hollow needle.

With the kyphoplasty procedure, a balloon is inserted and inflated into the compressed region of the vertebra. This creates a bony void where the fracture is, so that cement can be inserted to restore the bony structure to normal height. Without a kyphoplasty, the fracture will eventually heal in the collapsed position, which may cause kyphosis and pain long-term.

Who is a candidate for these procedures?pain procedure2

Research shows that people who sustain one osteoporotic fracture are five times more likely to suffer additional fractures. Therefore, people with osteoporosis and VCF that are still trying to heal are candidates for kyphoplasty or vertebroplasty.

Typically, spinal bracing and pain medication management is tried initially. If it fails to provide desired pain relief, then the procedure is indicated.

These procedures are not only for regular osteoporotic fractures, but also good for patients who have a metastatic tumor (cancer that spreads from another area), multiple myeloma (bone marrow cancer, or a vertebral hemangioma (benign tumor).

Will kyphoplasty or vertebroplasty improve old and chronic fractures?

These procedures do not improve old and chronic fractures. Also, they do not reduce back pain that is associated with stooping forward or poor posture.

Most doctors recommend having vertebroplasty or kyphoplasty when the VFC first occurs (within a couple months), to prevent further collapse. The pain doctor will conduct several diagnostic imaging tests to evaluate and make a diagnosis before determining if the procedure is right for you. An MRI can show if the fracture is still actively trying to heal and is the study of choice.

What happens before the procedure?

Before the surgery, you may be required to have some pre-surgical tests, such as blood tests, ECG, and chest x-ray. The doctor and staff will inform you on the procedure, and you will sign a consent form.

The doctor will advise you which medications you cannot take before surgery, such as blood-thinning agents. You are not permitted to eat or drink after midnight before surgery. When you arrive at the surgical Kyphoplastycenter, a nurse will place an IV catheter in your arm. You will be given general anesthesia or conscious sedation.

What happens during the procedure?

You will be positioned on your stomach for the procedure. The back region will be cleansed and prepped, and then the doctor injects a local anesthetic into the skin and tissues.

A small incision is made over the fractured vertebra, and with the aid of a fluoroscope (x-ray guidance), needles are inserted into the vertebral body. The doctor either inserts the inflatable balloon to restore height, or directly injects the bone cement under pressure. After completely filling the vertebral body, the needles are removed. The small incisions are closed with steri-strips, and a dry, sterile dressing is applied.

The bone cement hardens within 20 minutes, and acts as an “internal brace” for stabilization.

What happens after the procedure?

After the procedure, you are kept in the recovery room where a nurse monitors your vital signs and pain. After approximately one hour, you are asked to sit up, and after two hours, you are permitted to walk.

Some patients are kept in the hospital overnight for observation, whereas others are released home the kyphoplasty4same day. During the first 24 hours after your procedure, you should rest and only go to the bathroom and perform necessary activities. The doctor will advise you on gradual return to normal activities, and may prescribe physical therapy to assist with stretching, conditioning, and strengthening.

Are kyphoplasty and vertebroplasty effective?

In a large review of the two procedures (70 case series that comprised almost 6,000 VCFs), a significant reduction of pain was seen with both kyphoplasty and vertebroplasty in 90% of patients.

The pain relief extended for up to 2 years (kyphoplasty) and up to 5 years (vertebroplasty). In addition, both procedures improved patient functional status and quality of life long-term. Another study showed pain relief in 87% of patients who had vertebroplasty and 92% of those who had kyphoplasty.

Resources

Fourney DR, Schomer DF, Nader R, et al. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg. 2003;98:21–30.

Kasperk C, Hillmeier J, Noldge G, et al. Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res. 2005;20:604–12. doi: 10.1359/JBMR.041203.

Taylor RS, Taylor RJ, Fritzell P. Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine. 2006;31:2747–55. doi: 10.1097/01.brs.0000244639.71656.7d.