What is Kyphoplasty?
Most compression fractures of the spine are attributed to osteoporosis. Approximately 10 million people have osteoporosis, the prevalence is higher among the aging population. Compression fractures can result in increased pain, reduced exercise tolerance, worsening posture and poor pulmonary function. Kyphoplasty is a procedure that stabilizes the fracture, helps restore the height of the collapsed vertebral fracture and reduces the associated pain. Kyphoplasty involves injecting cement into a fractured vertebrae of the spine. Similar to vertebroplasty the primary difference is that kyphoplasty uses an additional step for creating space to inject the cement by employing a balloon like device.
How does Kyphoplasty work?
Kyphoplasty involves injecting cement percutaneously (through a small hole in the skin) into the fractured vertebrae of the spine. A small incision is made in the back through which an introducer cannula is placed. Under fluoroscopy the introducer cannula is advanced through the pedicle of the vertebrae and subsequently into the fractured vertebral body. After appropriate placement under live x-ray surveillance the doctor will then inflate a balloon apparatus that helps to create a cavity of space which will be used to eventually inject the cement. The balloon not only helps to create a cavity but also help restore some height back to the collapsed vertebral fracture. The balloon is then deflated and removed. Under low pressure a cement like material called polymethylmethacrylate (PMMA) is injected slowly into the cavity. Once injected this material quickly hardens and stabilizes the bone. The ultimate goal of the procedure is to stop the pain caused by a spinal fracture, stabilize the bone and to restore some if not all of the vertebral body height due to the compression fracture.
What are the indications for Kyphoplasty?
Kyphoplasty is indicated in the treatment of painful vertebral compression fractures caused by osteoporosis, some primary bone tumors, and metastatic disease. Most vertebral compression fractures occur in the thoracolumbar region. Often these fractures will be well delineated with MRI imaging or bone scan revealing the acuity of the fracture. Kyphoplasty tends to be more successful if the fracture is treated acutely within 6 months or if there is significant loss of height noted from the fracture. Besides restoring height of a collapsed vertebrae and improving kyphosis (hunchback), kyphoplasty may play a role in improving the pulmonary function in COPD patients with vertebral compression fractures.
How do I prepare for Kyphoplasty?
Kyphoplasty is a surgical procedure that is typically performed in the physician’s office suite or an ambulatory surgery center. Nothing to eat or drink after midnight the day prior to your procedure if you choose to get light sedation. If you are on blood pressure medications, you may take your AM dose with a small sip of water, otherwise hold off on taking your other medications. Consult with your physician at Capitol Pain about blood thinners as these will have to be held prior to the procedure as per safety guidelines.
What should I expect during my Kyphoplasty therapy?
Generally, with a more invasive procedure such as kyphoplasty it is recommended that one considerlight sedation to keep intra op pain at a minimum. An IV will likely be started in the pre-procedure area if sedation is provided for the procedure. You will then be brought back to the procedure room where you will lay belly first onto the exam table. Light sedation will then be started once you are comfortably laying down on the table. You may have pillows placed under your chest to help your surgeon with optimal positioning. Live x-rays (called fluoroscopy) will then be taken to ensure proper positioning and view of the spine. The area of the body that is targeted for kyphoplasty will then be cleaned via an antiseptic solution in a sterile technique with drapes placed afterwards. Once the site is prepped for the procedure local anesthesia will be applied to the targeted site to further reduce pain. Under fluoroscopy an introducer cannula will slowly be advanced to enter the pedicle of the vertebral body. Under multiple views the cannula is then further advanced into the center of the vertebral body near the anterior margin where the fracture is primary focalized. Once optimal placement is made with the cannula a balloon apparatus is inflated to build a cavity within the vertebral body for cement to eventually be injected into. The inflated balloon also helps restore the height of the compressed vertebral body and improve alignment of the spine. Cement (polymethylmethacrylate) is then administered under real-time fluoroscopy. Under careful review small increments of PMMA are injected into the cavity to make sure there is no extravasation outside of the bone or into the vessels. Once contrast flow is adequately spread into the vertebral body and vertebral body height and alignment are restored the cannula is removed and the incision site is cleaned with dressing placement.
What is the recovery time after Kyphoplasty therapy?
Pain relief will be immediate for some patients. In others, elimination or reduction of pain is reported within two days. Often patients may notice improvement in their posture such as a correction in a patient’s kyphosis or hunchback. At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.Patients should see their physician to begin or review their treatment plan for osteoporosis, including medications to prevent further bone loss.
Can I have sedation for Kyphoplasty therapy?
Since Kyphoplasty is noted to be one of the more invasive pain procedures light sedation may be recommended to provide more comfort to the patient Patients who are receiving sedation must have a responsible adult with them to drive them home.After the procedure is complete vitals will be checked frequently over the next 15 to 20 minutes. Once your vital signs are stable, you will be able to go home. Often patients will receive a low back brace following the procedure as a reminder to limit their activity following the procedure so that utmost relief will be experienced. Most patients prefer to have a family member or friend drive them for their procedure;however, you may drive yourself to the procedure as long as you are not requesting sedation.
What are the risks of the Procedure?
Although Kyphoplasty is of the more invasive pain procedures, risks can be mitigated with use of fluoroscopy and careful administration of PMMA. Potential risks from the procedure are rare but include infection, bleeding and bruising at the incision site, allergic reaction, nerve damage or spinal cord injury from potential leakage of the cement into the epidural space, as well as leakage into the vessels which could result in pulmonary embolism and death. It should be noted these risks are quite rare with appropriate safeguard measures of antiseptic technique and careful use of fluoroscopy.