Kyphoplasty
At a cost of 10 to 15 billion dollars every year, vertebral compression fractures (VCF) are the most common complication of osteoporosis (an age-related softening of the bones), the spread of tumor to the vertebral body, or by certain forms of cancer that can also weaken bone and cause the same problems. The bone cracks under pressure, causing it to collapse in height. The fracture may angle the spine forward and produce a hunchbacked appearance known as kyphosis. There are approximately 700,000 vertebral compression fractures per year in the U.S. that result in spinal deformity, acute/chronic pain, disability, and reduced vital respiratory capacity. Patients with this condition are subject to debilitating pain, disturbed sleep, decreased lung and intestinal function, and difficulty completing routine activities.
Overview
The vertebral body is the main structure treated with a kyphoplasty. It is a spinal surgery procedure that restores vertebral body height, provides fracture stability, and reduces pain associated with vertebral compression fractures. Kyphoplasty involves the placement of a balloon catheter through a needle introducer into the vertebral fracture, inflation of the balloon (which creates a cavity and restores vertebral body height) and injection of cement into the cavity. The indications for kyphoplasty include an osteoporotic or malignant spinal compression fracture, persistent back pain, progressive vertebral collapse, spinal deformity and a correct diagnosis from imaging studies. Contraindications consist of bone retropulsion with neurological complications, infection and greater than 80% loss of vertebral body height. Clinical studies demonstrate that kyphoplasty is a highly-effective treatment for compression fractures and provides correction of spinal deformities with significant pain relief, improved quality of life and increased physical function.
Kyphoplasty is not appropriate for:
• Patients with young, healthy bones or those who sustained a vertebral body fracture or collapse in a major accident
• Patients with spinal curvature, such as scoliosis orkyphosis, that results from causes other than osteoporosis; and
• Patients who suffer from spinal stenosis or aherniated disk with nerve or spinal cord compression and loss of neurologic function not associated with a vertebral compression fractures.
Treatment Advantage
Kyphoplasty gives physicians a way to mend a broken bone without the problems associated with open surgery. Unlike open surgery, which involves an incision and the use of larger instruments, kyphoplasty is a minimally invasive procedure, requiring a small opening in the skin and small instruments. This lessens the chance of bleeding, infection, and injury to muscles and soft tissues. The goal is to return the fractured vertebra as close as possible to its normal height. It is recommended that kyphoplasty be performed soon after a vertebral compression fracture happens to best restore vertebral.
Kyphoplasty is performed with the patient lying face down on the operating room table and under intravenous sedation. Two x-ray machines are used to show the collapsed bones. Two very small incisions are made in the back and a tube is inserted into the center of the vertebral body to the site of the fractured bone. A balloon is then inflated inside the fractured bone to restore the vertebral body to its normal height and shape. This inflation creates a cavity in the vertebral body, which is filled with bone cement. This special cement strengthens and stabilizes the vertebra. When the cement hardens, the tubes are removed and the incisions are closed with a single stitch. Patients are monitored in the recovery room for two to three hours after the procedure before going home with the instructions to move the back carefully and comfortably.
Quick Results
The cement used to fix the broken vertebra hardens quickly, within about 15 minutes; hence there is really no healing that needs to occur from the patient’s standpoint. Patients often find it easier to do daily activities within just one week. Pain will decrease rapidly and dimish completely. Most people require less pain medication within two weeks and do not need any form of physical therapy or rehabilitation. Patients rarely need to wear a brace after kyphoplasty, since the bone cement immediately improves the strength and stiffness in the fractured vertebra. In all, it takes approximately three months for the bone to heal completely after kyphoplasty and for the patient to fully return to all previous activities and full range of body motion.
