Kyphoplasty/Vertebroplasty

What is kyphoplasty/vertebroplasty?

Vertebroplasty and kyphoplasty are procedures for the treatment of the intense pain caused by vertebral compression fractures that do not respond to conventional therapies such as analgesic use, bed rest, and bracing. Both are ways to reinforce and stabilize the compressed vertebral body. The procedures result in similar relief of pain due to vertebral compression fractures. Vertebroplasty may also be applied preventatively to an at-risk vertebra between 2 other abnormal vertebrae.

How is kyphoplasty/vertebroplasty done?

Kyphoplasty/vertebroplasty are considered minimally invasive procedures that are most often performed using general anesthesia, depending on the doctor and your needs. During the procedure, you will lie on your stomach. With the guidance of xray fluoroscopy, the doctor will then insert a hollow needle, called a trocar, through the skin and into the vertebra.

Once the trocar is in place, either cement (vertebroplasty) or an inflatable balloon-like device (kyphoplasty) is inserted into the vertebra through the trocar. During a kyphoplasty, as the balloon is inflated, it opens up a space to be filled with bone cement. In most cases, this procedure is performed as an overnight stay, although many patients do go home the same afternoon. You may feel some soreness in the area where the trocar was inserted. However, this should resolve within a couple of days. Applying ice to the area can help relieve any soreness.

How effective is kyphoplasty/vertebroplasty?

Kyphoplasty/vertebroplasty usually provide pain relief and improved mobility within 72 hours of the procedures. In some cases, however, patients feel pain relief immediately. The majority of patients are satisfied with the results, with many returning to all their usual activities they were performing before the vertebral fracture occurred.

What are the risks?

Most complications are relatively minor and consist of cement leaks, transient fever and/or post-procedural discomfort (Adams, 2008). However, it is possible that other risks may occur, such as bleeding, infection, punctured lung, cement embolus, anesthesia-related events, and allergic reactions. You should speak with your doctor about the benefits and risks in your situation.

Who should not have this procedure?

There are a few cases in which vertebroplasty should not be considered for treatment of vertebral compression fractures. Contraindications include (Predey, et al., 2002): a healing fracture adequately responding to conservative therapy, concurrent blood clotting disorder, active infection especially of the bone, and older fractures, or fractures in which the majority of the vertebral body has collapsed. Because the injection of cement under pressure is likely to pass through the fracture into the spinal canal, a posterior cortical defect is considered a relative contraindication for vertebroplasty.

Kyphoplasty is not recommended for the treatment of fractures secondary to infection, most solid tumors, and vascular lesions nor is it indicated for the treatment of degenerative disk or joint disease. The presence of a burst fracture with loss of integrity of the posterior vertebral cortex and retropulsion of a fracture fragment into the spinal canal is also considered exclusionary.

Patients who have an allergy to any anesthetic, are on blood thinning medications, are diabetic, have an active infection, or are pregnant should consult with the pain physician before receiving the procedure. There may be special instructions or lab testing or the procedure might need to be rescheduled.

What happens afterwards?

Although pain is reduced or eliminated after the procedure, it is important to exercise caution in subsequent activities because other osteoporotic vertebral bodies may be prone to fracture. Medical management of the underlying disorder is essential. This procedure does not eliminate the need for aggressive treatment of osteoporosis, without which other fractures may ensue. Ideally, treatment should include Actonel; Fosamax; Miacalcin; calcium supplements; and multivitamins, including vitamins C and D. Hormonal replacement therapy should also be considered in female patients. Alterations in the medications and dosage of drugs that predispose the patients to osteoporosis (eg, steroids) should also be evaluated. Progress should be monitored with serial dual-energy x-ray absorptiometric (DEXA) scans. For complete medical treatment details, you should work closely with your primary care physician.

Is kyphoplasty/vertebroplasty right for you?

You might be a good candidate for kyphoplasty/vertebroplasty if you have severe back pain that correlates with a vertebral fracture, does not respond to conservative home and outpatient treatment, and is not caused by other problems such as disk herniation, arthritis, or stenosis. Imaging tests — such as spinal X-rays, bone scans, and computed tomography (CT) or magnetic resonance imaging (MRI) scans — might be ordered to confirm the presence of a vertebral fracture. Contact us for more information!

At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.

References:

Adams, J. (2008). Metabolic and Endocrine Skeletal Disease: Osteoporosis. Retrieved from Adam: Grainger & Allison’s Diagnostic Radiology, 5th Ed. MD Consult Website. Core Collection.

Kochan, J. & al., (2013) Percutaneous vertebroplasty and Kyphoplasty. Retrieved from Medscape website

Predey, T., & al., e. (2002). Percutaneous Vertebroplasty: New Treatment for Vertebral Compression Fractures. American Family Physician, 66(4):611-616.