Kyphoplasty/Vertebroplasty

Kyphoplasty and vertebroplasty are ultra-minimally invasive surgical procedures that treat vertebral compression fractures of the spine. Both procedures stabilize a spinal compression fracture in the spine to alleviate pain and prevent further loss of vertebral body height.

Compression fractures are estimated to affect 1.5 million Americans each year. They are most common in the elderly, with 25% of postmenopausal women affected by a compression fracture during their lifetime. Most occurrences of these fractures do not require hospitalization.

Compression fractures have the potential to cause significant morbidity and disability, resulting in major back pain for several months.

Osteoporosis caused by bone density loss is the most common condition that can cause vertebral spinal compression fractures. When a vertebra collapses due to a compression fracture, the fracture itself can be painful or cause irritation or even narrowing around spinal nerves resulting in excruciating pain.

What is the difference between vertebroplasty and kyphoplasty?

Kyphoplasty and vertebroplasty are effective treatment options to reduce pain caused by a vertebral body compression fracture.

Vertebroplasty works percutaneously through the skin to inject bone cement into the vertebral body’s cancellous bone to stabilize the fracture and alleviate pain. The cement interdigitates within the fracture crevices.

Kyphoplasty utilizes an inflatable balloon deployed in the fractured vertebral body creating a cavity for the cement to be injected. The balloon potentially restores the height of the vertebral body and improves alignment by reducing kyphosis (outward curvature of the spine, causing hunching of the back).

Who is a candidate for kyphoplasty/vertebroplasty procedures?

Patients with increasingly painful back pain caused by osteoporosis or vertebral compression fractures may be good candidates for vertebroplasty or kyphoplasty.

Patient candidates for these procedures typically have reduced physical function and ability to move because of the fractures in their spine.

Am I a Candidate?

Kyphoplasty/Vertebroplasty candidate’s pain must have the following criteria:

Pain due to vertebral fracture
Not related to arthritis, stenosis, or herniated disk
Imaging tests – MRI, bone scans, spinal x-rays, or computed tomography (CT) – confirm the presence of a vertebral fracture
If osteoporotic – a dual-energy x-ray absorptiometry (DXA) scan may also be helpful to establish a baseline for bone density

What type of anesthesia is used during vertebroplasty or kyphoplasty procedure?

Three types of anesthesia are available for patients and their physicians. Patients undergoing vertebroplasty or kyphoplasty can be offered an epidural analgesic (local anesthetic), IV sedation, or general anesthesia.

The anesthetic used varies according to the specific condition of each patient and the medical team performing the procedure. Each anesthesia has been studied and found effective in helping patients to be comfortable during the procedure.

How is the kyphoplasty and vertebroplasty procedure performed?

Both kyphoplasty and vertebroplasty are ultra-minimally invasive outpatient procedures, with most patients going home that same day. After meeting with the anesthesia and your spine surgeon to answer last-minute questions, the nurse will roll you back on a stretcher to the operating room. The procedure usually consists of five steps which generally last about one hour.

Step One: patient prepped – the anesthesiologist will administer an anesthetic. Once sedated, the operating room staff will position you comfortably on your stomach on the operating room table. Your back will be cleansed, sterilized, and prepped for the procedure to start.

Step Two: needle placement – your surgeon will begin by injecting a local numbing anesthetic in the area over the fracture vertebrae is located. Under fluoroscopic guidance, the surgeon directs a hollow needle called a trocar through your skin to the affected center of the fractured vertebra.

Step Three: stabilize and restore vertebra height (kyphoplasty only) – through the trocar needle, the surgeon deploys a balloon in the collapsed vertebra. The balloon is then inflated, which creates a cavity and may distract the vertebral endplates to restore vertebral height. The balloon is then deflated and removed.

Step Four: inject bone cement – both vertebroplasty and kyphoplasty inject bone cement which fills and stabilizes the fracture. The amount of cement and pressure is constantly monitored under fluoroscopy to avoid leaks into the spinal canal. Stabilizing the fracture will significantly reduce the pain.

Step Five: dress approach site – the needle/trocar is removed, the small incision is dressed with Steri-Strips placed on the skin and an additional bandage is applied. Once the bone cement has hardened, the patient is moved from the operating room table to the stretcher and taken to recovery for a short period.

What happens after kyphoplasty/vertebroplasty surgery?

During recovery, the clinical team will monitor your heart rate, blood pressure, and respiration. They will assess your pain and medication prescribed by your surgeon with instructions for use after leaving the facility. Patients may sit up shortly after the procedure, get up, and walk after an hour. Some patients may stay overnight for observation and be released the following morning. Most patients can go home that same day. Patients should have someone drive them home and have assistance around the house for the first 48 hours.

Surgeon’s Homecare Instructions After Kyphoplasty/Vertebroplasty

Your specific surgeon will have recommended homecare instructions to follow over the first two weeks after the procedure. Here are some basic recommendations you can expect:

Restrictions – first 72 hours

Avoid twisting, turning, and bending your back.
Do not lift anything heavier than five pounds.
No strenuous activity such as housework, manual labor, yard work, and sex.
Do not drive while taking any pain narcotic or muscle relaxer medication.
If pain is controlled without these medicines, you can drive.
Please don’t drink alcohol as it can thin the blood and increase the risk of bleeding.
Also, never mix alcohol with pain medications.

Physical Activity

Try to walk 5-10 minutes every few hours and gradually increase the walking duration as you feel able to. After the first 72 hours, you can increase physical activities as tolerated and return to all physical work.

Incision Care

Incisions are typically closed with dissolvable sutures or covered with Steri-Strips.
72 hours after surgery you will be able to remove the bandage and shower.
The incision and Steri-Strips can get wet 72 hours after surgery, but we do not recommend directly washing the incision.
After showering pat the incision and Steri-Strips dry.
If there is no drainage from the incision site, you can leave the Steri-Strips open to air.
You may re-cover the incision if you feel more comfortable with it covered.
Contact our office with any signs of infection; excessive redness, swelling, excessive drainage, fever, or chills.
No Jacuzzi, bathtubs, or swimming pools until cleared by your physician.

Medications

Always follow directions on taking pain medications as prescribed by your doctor. Never take more medicine than prescribed. Some pain medications can cause addiction habits. If you have breakthrough uncontrolled pain, it is best to call and speak to the nurse or make an appointment.
If your pain is subsiding, do not take the pain medication if not needed.
Narcotic medication can cause constipation. Make sure to drink lots of water daily and eat fiber-rich foods. Laxatives and stool softeners can help with bowel movement.

What to Watch Out For

The following symptoms can indicate a potential problem. You should call the office to notify the surgeon as soon as possible.

Fever greater than 101F
New numbness or pain symptoms after surgery – especially if you had immediate back pain relief from surgery and then new constant or increasing pain.
Swelling, redness, or excessive drainage from the incision
Severe headaches that are worse when you are standing

If you have any questions after surgery or experience these symptoms, please call 602-944-2900. Our on-call service will answer calls after hours, and they will page the surgeon in case of an emergency. Otherwise, calls will be returned the following business day.

If you experience any of the following symptoms, please call immediately or dial 911 to go to the emergency room at your local hospital:

Severe chest pain, breathing difficulty
Paralysis or loss of ability to move your legs
Loss of control of your bladder or bowel

Most Frequently Asked Questions About Vertebroplasty/Kyphoplasty

What are the benefits and risks of kyphoplasty/vertebroplasty?

The kyphoplasty procedure has been performed on more than 1 million patients safely and effectively over the past 20 years. Balloon kyphoplasty has been clinically proven to relieve pain and restore vertebral body height and deformity. Patient benefits from kyphoplasty include:

Improved quality of life and daily activities
Improved mobility
Fewer days per month that pain affects daily activities

The safety of kyphoplasty/vertebroplasty is like nonsurgical measures with a low complication rate. As with any surgical procedure, there are potential for serious adverse events; however, low such as:

Heart attack
Cardiac arrest
Stroke
Embolism (fat, blood, or cement that migrates to the lungs)
Death
Reaction to anesthesia

Other risks can include – infection and leakage of bone cement into surrounding tissue around the spinal cord. On rare occasions, there can be a risk of paralysis and cement leaking into blood vessels resulting in damage to vessels, lungs, and heart.

Am I a candidate for kyphoplasty/vertebroplasty?

You have two options if you have been diagnosed with an acute spinal vertebral compression fracture.

You may be prescribed pain medication and bed rest until it heals over several weeks or months (nonsurgical measures). The other option is a surgical procedure called kyphoplasty or vertebroplasty which can stabilize the fracture.

Your physician can refer you to a specialist who performs kyphoplasty. They can explain the benefits, risks, and if you are a good candidate for the procedure.

What is the difference between kyphoplasty and vertebroplasty?

As previously explained above, both procedures are similar in that they are ultra-minimally invasive surgical procedures that treat vertebral compression fractures of the spine. Both procedures are vertebral augmentation that relieves back pain and stabilizes a spinal fracture using bone cement.

Kyphoplasty, unlike vertebroplasty, utilizes a balloon to expand the fracture and injects cement. This procedure has been shown to restore vertebral body height.

How long does the vertebroplasty/kyphoplasty procedure last?

Both vertebral augmentation procedures take about a half hour per spinal level treated. The procedures are ultra-minimally invasive, and if performed outpatient at a surgery center or office procedure room, patients go home the same day. If performed at a hospital, patients generally go home the next day.

When can patients go back to work?

Most patients experience pain relief and improved mobility within 48 hours and, in some cases, immediately after surgery. Most patients can return to work a day or two later once the pain from the incisions has subsided. There are usually no physical restrictions after 72 hours, and the patient’s pain has been relieved.

Contact DISC Today for Treatment of Back Pain

Your physician can explain the benefits, risks, and if you are a good candidate for the Kyphoplasty/Vertebroplasty procedure.

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