KYPHOPLASTY
Kyphoplasty is a minimally invasive spinal surgery procedure. It is used to treat painful progressive vertebral body collapse/fracture (VCFs). The VCFs may be caused by osteoporosis or the spread of tumor to the vertebral body.
Osteoporosis is age related softening of bones. It causes the building blocks of the spine to weaken and collapse. This results in severe pain and a progressive hunchback. Certain forms of cancer also weaken the bone and cause the same problems.
Kyphoplasty is not appropriate for:
* Patients with young, healthy bones or those who sustained a vertebral body fracture or collapse in a major accident
* Patients with spinal curvature such as scoliosis or kyphosis that is due to causes other than osteoporosis
* Patients who suffer from spinal stenosis or herniated discs with nerve or spinal cord compression and loss of neurological function not associated with a vertebral compression fracture
The kyphoplasty procedure involves the use of a balloon to restore the vertebral body height and shape. This is followed by bone cement to strengthen it. The procedure may be performed under intravenous sedation. The patient may need local anesthetic or general anesthetic. The patient lies face-down on the operating room table. Two X-ray machines are used to show the collapsed bones.
The surgeon makes two small (less than 3mm) incisions. He or she inserts a tube into the center of the vertebral body. Through this tube, balloons are placed in the center of the vertebral body. (See Figure 1.) Then the balloons are inflated. (See Figure 2.) This pushes the bone back towards its normal height and shape. It also helps create a cavity. The surgeon will fill the cavity with the bone cement.
Once the cavity is created, the surgeon removes the inflatable balloon bone tamp. He or she mixes the cement and fills the cavity in a slow and controlled fashion. (See Figures 3 and 4.) The cement hardens. Then the surgeon takes out the tubes. He or she closes the incisions with a single stitch. Patients usually go home the same day. Patients can go back to all normal activities of daily living as soon as possible. They have no restrictions.
Early results show kyphoplasty is a safe and effective method of vertebral reconstruction and stabilization in the treatment of osteoporotic VCFs. Like all surgeries, kyphoplasty does have risks.
Complications may require additional treatments. These may be medications or surgery. Kyphoplasty is associated with excellent pain relief due to the vertebral body collapse. Well over 95 percent of patients rate their treatment a success. They are able to return to all of their pre-VCF function. Patients typically do not need any form of physical therapy or rehabilitation after a kyphoplasty procedure. Because bone cement hardens within 15 minutes, there is really no healing that needs to happen from the patient’s standpoint.
Occasionally, patients complain of persistent pain after kyphoplasty. This may be due to irritation of tissues involved in the procedure itself. It is more likely due to the underlying arthritis and degeneration of the spine.
* Pain due to the procedure will typically diminish within two weeks.
* If the pain is due to the arthritic degenerative changes in the spine, the usual treatment is medications and an ongoing exercise program.
Restoring vertebral body height and size is best accomplished when kyphoplasty is performed soon after the VCFs happen. (See Figures 5 and 6.) After kyphoplasty, severe osteoporosis may cause other fractures at other levels in some patients. All patients must take bone-strengthening medications during treatment. If more vertebrae collapse, kyphoplasty can also be used at those other levels. Kyphoplasty has a tendency to help prevent more fractures. It keeps the spine lined up in its native upright position.
* The usual risks of local or general anesthetics apply. These risks depend on the patient’s overall health.
* There is a small risk of the bone cement leaking from within the boundaries of the vertebral body. In most cases, this rare event (occurrence less than 10 percent) does not cause any problems.
* In very rare circumstances the cement may irritate or damage the spinal cord or nerves. This can cause pain, altered sensation, or even, very rarely, paralysis (estimated risk is less than 1 in 10,000). Should the cement leak further, more significant surgery may be needed to stop the irritation of the nerves or spinal cord.
* There is also a very small chance of the cement traveling to lungs. There is an even smaller chance of the cement block becoming infected at the time of surgery or even years later.
VERTEBROPLASTY
The procedure is performed while the patient is awake but sedated, and lying facedown so the physician has access to the back. The back is numbed by a local anesthetic. At Mayo Clinic, the procedure is performed by an interventional spine neuroradiologist — a physician with special expertise in the nerves, brain and spinal cord.
Through a small incision and guided by a fluoroscope, the neuroradiologist passes a hollow needle through the spinal muscles and into the fractured vertebra. X-ray cameras above, below and on the sides of the table provide guidance for needle placement. When the needle is in the correct position, bone cement is injected through the needle into the vertebra. As a rule, the procedure takes one hour for each vertebra that is treated.
After the procedure, patients lie flat on their backs for two hours while the cement hardens. They are then discharged and can resume normal activity. The majority of patients have significant pain relief within a few days.
Advantages of Vertebroplasty
Vertebroplasty is considered for patients with painful compression fractures in the spine, often caused by osteoporosis. Because the treatment often results in a dramatic decrease in pain, the advantages are numerous.
Decreased pain— A compression fracture causes sharp and debilitating pain. Those suffering from these fractures are often prescribed bed rest and pain medication. Vertebroplasty reduces and in some cases eliminates the need for pain medication, and it also restores mobility in many patients.
Increased functional abilities— The pain from a compression fracture is usually sharp and debilitating, leaving people unable to perform everyday tasks. Vertebroplasty stabilizes the fracture, decreases pain dramatically and allows a return to the previous level of activity.
Prevention of further vertebral collapse—The cement fills spaces in bones made porous by osteoporosis, strengthening the bone so that it is less likely to fracture again.
