What is Kyphoplasty?
Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of vertebral compression fractures (VCF), which are fractures involving the vertebral bodies that make up the spinal column.
When a vertebral body fractures, the usual rectangular shape of the bone becomes compressed, causing pain. These compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous, and vulnerable to breaking. Vertebrae may also become weakened by cancer.
In vertebroplasty, physicians use image guidance to inject a cement mixture into the fractured bone through a hollow needle. In kyphohplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed.
What to Expect
Vertebroplasty involves injecting a cement mixture into the empty spaces within weakened vertebrae to strengthen them and provide pain relief. Using image-guidance, a hollow needle called a trocar is passed through the skin into the vertebral body for injection of the cement mixture into the vertebra.
In kyphoplasty, a balloon is first inserted through the trocar, into the fractured vertebra where it is inflated to create a cavity for cement injection. The balloon is removed prior to injecting cement into the cavity that was created by the balloon.
Image-guided, minimally invasive procedures such as vertebroplasty and kyphoplasty are most often performed by a specially trained interventional radiologist. This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted. You will be positioned lying face down for the procedure. You may be connected to monitors that track your heart rate, blood pressure and pulse during the procedure. A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. Moderate sedation may be used. As an alternative, you may receive general anesthesia. You may be given medications to help prevent nausea and pain, and antibiotics to help prevent infection.
The area through which the hollow needle, or trocar, will be inserted will be shaved, sterilized and covered with a surgical drape. A local anesthetic is then injected into the skin and deep tissues, near the fracture.
A very small nick is made in the skin at the site. Using x-ray guidance, the trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra.
In vertebroplasty, the orthopedic cement is then injected. Medical-grade cement hardens quickly, typically within 20 minutes. In kyphoplasty, the balloon tamp is first inserted through the needle and the balloon is inflated, to create a hole or cavity. The balloon is then removed and the bone cement is injected into the cavity created by the balloon. X-rays and/or a CT scan may be performed at the end of the procedure to check the distribution of the cement. The trocar is removed after the cement is injected. Pressure will be applied to prevent any bleeding and the opening in the skin is covered with a bandage. No sutures are needed.
This procedure is usually completed within one hour. It may take longer if more than one vertebral body level is being treated.
Patient Preparation
A clinical evaluation will be performed to confirm the presence of a compression fracture that may benefit from treatment with vertebroplasty or kyphoplasty. The evaluation may include diagnostic imaging, blood tests, a physical exam, spine x-rays and a radioisotope bone scan and/or magnetic resonance imaging (MRI).
You may be given bone-strengthening medication during treatment. You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred to as “dye” or “x-ray dye”). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure. You will need to have blood drawn for tests prior to the procedure to determine if your blood clots normally.
On the day of the procedure, you should be able to take your usual medications with sips of water or clear liquid up to six hours before the procedure. You should avoid drinking orange juice, cream and milk.
In most cases, you should take your usual medications, especially blood pressure medications. These may be taken with sips of water on the morning of your procedure. Other than medications, you may be instructed to not eat or drink anything for several hours before your procedure. You should plan to have a relative or friend drive you home after your procedure.