Minimally Invasive Kyphoplasty for Vertebral Compression Fractures
What are vertebral compression fractures?
It is estimated that 1.5 million people in the U.S. are affected by vertebral compression fractures (VCFs) each year. VCFs occur when the bones in the spine weaken and collapse, and although most heal on their own, the injury can persist and fail to heal in those with underlying musculoskeletal conditions or osteoporosis. This can lead to severe back pain, deformity of the spine, a loss in height, and an inability to complete activities of daily living without assistance. VCFs have become more and more common with age and are also seen in victims of automobile accidents, spinal tumors, and sports injuries. The rising number of severe VCF cases each year calls for an effective, long-lasting treatment that will both consolidate the fracture and correct the curvature of the upper spine.
What is kyphoplasty?
Kyphoplasty , occasionally referred to as balloon vertebroplasty, is a minimally invasive vertebral augmentation procedure that involves the placement of cement into fractured vertebrae to relieve back pain caused by VCFs that will not heal on their own. Kyphoplasty is very similar to vertebroplasty in that it involves an acrylic bone cement injection, but different due to an additional step that aims to restore the curvature and overall height of the spine. This is done by inserting and inflating a small balloon into the fractured vertebra(e), hence the name “balloon” vertebroplasty, to create excess space for the bone cement. Candidates for the procedure are those whose vertebrae were damaged and collapsed due to osteoporosis, cancer, or spinal fractures. However, those with arthritis of the back, herniated disks, or scoliosis are not recommended for this procedure.
How is the procedure performed?
To prepare you for the procedure your doctor will order a blood test as well as an X-ray or MRI to locate the fracture(s) in your spine. Once the imaging is reviewed, your physician will determine whether you are a good candidate for the procedure. The day of the procedure you will receive anesthesia through an IV in a vein in your arm as well as anti-nausea, pain medication, and antibiotics if necessary. You will be lying in a face-down position throughout the procedure. The region in which the needle will be inserted may be shaved if needed, and then cleaned and sterilized. The procedure will generally follow these steps. Your physician will first insert a hollow needle called a trochar into your skin and guide it to the desired location using imaging. They will then insert a device called a balloon tamp through the trocar into the bone and inflate it to restore the height of the vertebrae and create space for the bone cement. The cement will then be injected. Once the cement has been confirmed to be filling the space on imaging, the physician will remove the needle and bandage the area. Due to the minimally invasive nature of the procedure, stitches are not needed. Kyphoplasty generally takes around one hour for each vertebra being treated.
Following the procedure, you will be monitored in a recovery room and encouraged to walk around once you are ready. Depending on how many vertebrae the procedure involved and your general health, you should be able to go home the same day. Your physician will counsel you on how to return to your normal daily activities as well as prescribe any necessary medications or bone-strengthening supplements. You can expect some soreness at the injection site for up to 72 hours after the procedure, which can be alleviated with an ice pack. The risk of complications are less than 2%, however, possible risks include an allergic reaction to the fluoroscopy solution, nerve damage, infection, bleeding, or leaking of the acrylic bone cement.
Ultimately, the goal of kyphoplasty is to alleviate back pain caused by VCFs by stabilizing the affected vertebra and restoring the natural curvature and height of the spine. For patients suffering from VCFs, kyphoplasty can be a reliable, safe, and long-lasting alternative to dangerous opioids and narcotics. The procedure has the potential to improve your quality of life and mobility which can be life changing for these patients.
Author: Nawal Panjwani
Editor: Ospina Medical Team