Kyphoplasty and Vertebroplasty
Kyphoplasty and Vertebroplasty are minimally invasive spinal surgical procedures that are designed to treat painful, progressive, osteoporotic fractures. These compression fractures often involving the thoracic or lumbar spine and may occur from traumatic injury or even minimal stress on the spine.
Osteoporosis is a prevalent disease in our society that slowly weakens the bones, often leading to fractures and disability. According to the National Osteoporosis Foundation, osteoporosis is a major public health threat for 28 million Americans, 80% of whom are women. One out of two women and one out of eight men suffer an osteoporosis related fracture.
Osteoporotic bones are no longer strong structural building blocks. These bones tend to be strong on the outside and quite weak on the inside, much like the brittle shell of an egg. As age-related weakening of the bones occurs, painful fractures can occur in the spine. Vertebral compression fractures go hand-in-hand with severe osteoporotic disease in active, elderly patients. Forty percent of all women will have at least one compression fracture by the time they turn 80 years old.
For many sufferers of osteoporosis and arthritis, a compression fracture in the spine can be a cause of severe and disabling back pain. A compression fracture occurs when the vertebral body collapses, causing the front part of the vertebral body to become wedge shaped. The vertebral body is crushed, or compressed. A compression fracture may alter the normal alignment of the spine resulting in scoliosis or kyphosis of the spine. These fractures can take months to heal. The typical treatment for a compression fracture is bracing and pain medications. Typically a brace is used for three months while the bone heals. During that time there is significant discomfort and the patient must wear a hard, plastic, clamshell-type brace. The bracing acts as a cast around the abdomen and chest and supports the weight of the upper body on the lumbar spine. These are relatively effective in decreasing pain, stabilizing the fracture to prevent further compression, and maintaining posture. Short of using medications and bracing, there are a few minimally invasive surgical options that can be used to treat people who have these broken bones in the low back. The existing minimally invasive procedures are known as vertebroplasty and kyphoplasty.
Both vertebroplasty and kyphoplasty procedures involve placing cement into the fractured vertebra through small, minimally invasive incisions in the skin under x-ray guidance. Not every compression fracture is a good candidate for these treatments. Your spinal specialist will determine if this is appropriate for you based on your specific fracture.
In vertebroplasty, bone cement is injected under pressure directly into the fractured vertebra and quickly hardens to solidify fractured fragments and provide immediate stability. In kyphoplasty a balloon catheter is used to actively restore collapse and correct abnormal wedging of the broken vertebra. The balloon inflates the crushed bone in an attempt to restore or improve the shape and the height of the bone in the spine. The balloon creates an empty void that once deflated and removed is filled in with quick-setting bone cement that rapidly hardens.
Both procedures are done under x-ray guidance. This ensures that the needle and balloon are placed in the proper position. By inflating the balloon or in some cases, two balloons, the broken bones can be pushed back into a more normal position. We can see the cement using fluoroscopy (x-ray), because there is a dye material mixed in with the cement to make it visible under x-ray.
These procedures can be performed under light ‘twilight’ sedation or under general anesthesia. To ensure the comfort of our patients, we always use local anesthetic. Small incisions are made to perform these procedures, so patients heal in a short amount of time and need only a few small stitches or skin tapes. The procedures are generally outpatient or may require an overnight stay. Patients report rapid improvement in their pain and posture. Depending on the severity of the osteoporosis, some patients still require temporary bracing until the pain and muscle injury improve. Patients typically do not need any form of physical therapy or rehabilitation after these procedures, because the bone cement hardens within fifteen minutes. However, the surrounding soft tissues, such as ligaments and muscles can take a number of days or weeks to calm down from the local irritation.
Vertebroplasty and kyphoplasty are safe and effective treatments for stabilizing the spinal column when indicated. It represents an alternative given the discomfort and persistent pain associated with bracing for several months.
As with any surgery, there are possible surgical complications. There is a small risk that cement placed in the vertebral body may leak to abut the spinal cord or the adjacent nerve branches. In most cases, this is a relatively rare event and does not cause problems. Rarely, cement may irritate the spinal cord and the nerves requiring urgent surgical intervention.
Vertebroplasty and kyphoplasty are two means of using a minimally invasive approach to attempt to restore the height of broken spinal bones and improve posture. This is one way that we are improving the lives of our patients and more importantly, improving the quality of their lives. If you have any questions about vertebroplasty or kyphoplasty, contact your spinal experts at Virginia Spine Institute.
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