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Kyphoplasty & Vertebroplasty

Vertebroplasty and kyphoplasty are minimally invasive procedures performed to treat vertebral compression fractures (VCF) of the spine. These fractures, which can be painful and limit spine mobility, are commonly caused by osteoporosis, spinal tumors, and traumatic injury. Traditional treatments ofbed rest, pain medication, and braces are slow to relieve the pain. By injecting bone cement into the fractured bone and restoring the vertebra height, these procedures offer patients faster recovery and reduce the risk of future fractures in the treated bone.

What are Vertebroplasty & Kyphoplasty?

In vertebral compression fractures (VCF), the body collapses into itself (more in the front than the back) producing a “wedged” vertebra. When several vertebrae become wedge-shaped, people can develop a humped spine, called kyphosis. People with bones weakened by osteoporosis (a depletion of calcium) or multiple myeloma (cancer of the bone marrow) are especially prone to compression fractures. Activities, such as lifting a heavy object, sneezing, or coughing may cause fractures. VCFs can lead to back pain, reduced physical activity, depression, loss of independence, decreased lung capacity, and difficulty sleeping. 

Vertebroplasty and kyphoplasty are similar procedures. Both are performed through a hollow needle that is passed through the skin of your back into the fractured vertebra. In vertebroplasty, bone cement (called polymethylmethacrylate) is injected through the hollow needle into the fractured bone. In kyphoplasty, a balloon is first inserted and inflated to expand the compressed vertebra to its normal height before filling the space with bone cement. The procedures are repeated for each affected vertebra. The cement-strengthened vertebra allows you to stand straight, reduces your pain, and prevents further fractures.

Without treatment, the fractures will eventually heal, but in a collapsed position. The benefit of kyphoplasty is that your vertebra is returned to normal position before the bone hardens. Patients who’ve had kyphoplasty report significantly less pain after treatment.

Studies show that people who get one osteoporotic fracture are 5 times more likely to develop additional fractures. It is important that people seek treatment for osteoporosis early, before fractures occur.

Who is a candidate?

Vertebroplasty or kyphoplasty may be a treatment option if you have painful vertebral compression fractures from:

  • Osteoporosis (a depletion of calcium in bones)
  • Metastatic tumor (cancer spread from another area)
  • Multiple myeloma (cancer of the bone marrow)
  • Vertebral hemangioma (benign vascular tumor)

You may not be a candidate if you have:

  • Non-painful stable compression fractures
  • Bone infection (osteomyelitis)
  • Bleeding disorders
  • Allergy to medications used during the procedure
  • Fracture fragment or tumor in the spinal canal

Vertebroplasty and kyphoplasty will not improve old and chronic fractures, nor will they reduce back pain associated with poor posture and stooping forward. Traditional treatment used to involve waiting 4 to 6 weeks to see if patients improved on their own, but now it’s believed that waiting allows the bone to harden, making vertebroplasty or kyphoplasty less effective. Many doctors are now suggesting vertebroplasty as soon as the first week after a fracture for some patients because the results are significantly better.

The surgical decision

The doctor will perform a complete medical history and physical exam. Diagnostic studies (MRI, CT, bone scan) may be included in your evaluation to make a diagnosis of vertebral compression fracture. Your doctor will also determine if your spine is “stable” or “unstable” and will discuss with you all treatment options.

What are the results?

The sooner a fracture is repaired, the better the results. Vertebroplasty and kyphoplasty are fairly new procedures that have only been available since 1984, so long-term results are not yet available. Vertebroplasy relieves pain in 75-90% of patients; however, it does not correct the wedge deformity, which can lead to repeat fractures.

In a recent study of kyphoplasty (which can correct the wedge deformity), pain levels in patients dropped from an average of 8.6 before surgery (on a 10-point scale) to 2.1 three months after surgery.  In our experience, this is the one procedure in which pain reduction takes place immediately and most patients walk out of the office Pain-Free!  Additionally, of 51 patients who either couldn’t move around on their own or required assistance to move, only 8 patients couldn’t move around without assistance after three months. This reduction in pain and increased ability to move significantly improved the patients’ quality of life. Other studies in cancer patients with multiple myeloma have shown similar results.

What are the risks?

No procedure is without risks. General complications of any procedure include bleeding, infection, blood clots, and reactions to anesthesia. Complications in the treatment of vertebral compression fractures is less than 2%, and 5 to 10% in the treatment of tumors. The following are specific risks that should be considered:

Bone cement leakage. There is a slight possibility that bone cement can leak along the outside of the needle into surrounding soft tissues. This can also happen when the needle is removed from the vertebra. Cement can leak into the veins surrounding the vertebra. The doctor closely watches the fluoroscope and stops injecting cement if this begins to happen. Cement can leak into the neural foramen where the spinal nerve exits the spinal cord. This can cause nerve pain (radiculopathy) and may require further treatment.

Nerve damage. Any procedure on the spine comes with the risk of damaging the spinal nerves or cord, which can cause numbness or paralysis.

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Delve into the spine and how it functions within the human musculoskeletal system and the body as a whole. This is the first edition of The Spine Owner’s Manual, a companion book to Orthopedics 2.0.

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