Kyphoplasty

What is Kyphoplasty?

Balloon vertebral augmentation, or Kyphoplasty, is a minimally invasive procedure in which bone cement is used to stabilize fractures in the thoracic or lumbar spine. During the procedure, vertebral body height that was lost due to the fracture may also be restored. It provides long-term pain relief for many patients suffering from pain caused by a vertebral fracture, and may correct deformity caused by the fracture. This procedure was developed in the 1990s and has been in widespread use since then to treat fractures caused by osteoporosis and cancer. Osteoporotic compression fractures are among the most common causes of spinal pain in older Americans. One third of women and one in eight men over the age of 50 have osteoporosis, and many will go on to suffer compression fractures if untreated.

Vertebral Compression Fracture (image from Medtronic):

Am I a candidate for Kyphoplasty?

Your board-certified pain management physician at Pain Management Specialists determines if you’re a candidate for Kyphoplasty after an evaluation and review of spinal imaging.

People who respond best to Kyphoplasty have severe, poorly controlled back pain with movement that is caused by a recent vertebral fracture and no other condition that better explains their back pain. Vertebral fractures are more likely in people with osteoporosis (weak bones) and certain types of cancer that may spread to the spine and weaken it. In most cases, the onset of pain is sudden and is not typically caused by trauma. Kyphoplasty may also be used to treat pain caused by a vertebral hemangioma, a blood vessel malformation which may weaken the bone. Some patients with vertebral fractures are not good candidates for Kyphoplasty, including those with leg numbness or weakness caused by the fracture, with severe narrowing around the spinal nerves, with an unstable fracture or infection at the site of the fracture.

An x-ray shows a vertebral fracture and may demonstrate osteoporosis, but cannot tell whether it is a new or old fracture. MRI is the study of choice to determine whether the suspected painful fracture is a recent one, to rule out other conditions like infection and disc herniation, and to confirm that the fracture has not compressed adjacent nerves. MRI may also identify tumors, but biopsy is required to confirm the type of tumor. If you cannot have an MRI, CT and bone scan are alternatives. Biopsy may be done during the Kyphoplasty procedure.

What happens during Kyphoplasty?

Your Pain Management Specialists doctor performs Kyphoplasty in the office, an outpatient surgery center or hospital operating room, depending on your general health, the location of the fracture and need for anesthesia. Kyphoplasty may be performed with sedation or under general anesthesia. The procedure typically takes 20 to 40 minutes, depending on how many vertebrae are being treated.

During your Kyphoplasty you are positioned on your stomach. The skin overlying the fracture is cleaned and an intravenous antibiotic is administered to prevent infection.

Next, your doctor makes a small (roughly 1 centimeter) incision in your back and inserts a trocar into the affected vertebral body (bone) using X-ray guidance. After precisely positioning the trocar in the fracture, a balloon-tipped catheter is inserted and the balloon is inflated with liquid to create a void within the bone and to restore vertebral body height. In most cases, a second balloon is placed into the fracture from the opposite side to maximize the ability to restore vertebral body height. The balloon is then removed and enough bone cement is injected into the void to stabilize the fracture. The trocar is then removed and the cement is allowed to harden. After your Kyphoplasty, you will need to spend a short time in the recovery room before going home. You must arrange to have someone drive you home after the procedure.

Bilateral balloon Kyphoplasty (image from Metronic):

When will I feel pain relief after Kyphoplasty?

Pain from Kyphoplasty is usually mild and temporary. Many patients start to experience relief of their usual pain within days after the procedure. Studies have shown that patients who get Kyphoplasty for their vertebral fractures experience less chronic back pain, improved quality of life, decreased need for pain medication and decreased risk of death.

What are the risks of Kyphoplasty?

As with most surgical procedures serious adverse events, some of which can be fatal, can occur, including heart attack, cardiac arrest (heart stops beating), stroke, and embolism (blood, fat or cement that migrates to the lungs or heart). Other risks include infection; leakage of bone cement into the muscle and tissue surrounding the spinal cord and nerve injury that can, in rare instances, cause paralysis; leakage of bone cement into the blood vessels resulting in damage to the blood vessels, lungs and/or heart.

What are the alternatives to Kyphoplasty?

• Pain medications
• Bed rest
• Back braces
• Physical therapy
• Surgery

The Pain Management Specialists team has been on the forefront of offering the latest proven treatments to patients. They are among very few interventional pain management practices in the area trained to evaluate and treat patients with Kyphoplasty. To learn more about the Kyphoplasty and how it may alleviate your back pain, call Pain Management Specialists or book an appointment online today.