Vertebroplasty & Kyphoplasty
Vertebroplasty and kyphoplasty are procedures used to treat painful vertebral compression fractures in the spinal column. Compression fracture of the vertebral body is common. It is more common in the bones of the lower spine (thoracic and lumbar). Many vertebral compression fractures will heal on their own.
Vertebral compression fractures can cause severe back pain leading to inability to perform daily activities, and in some cases, a kyphotic (hunched-over) deformity. Thinning of bones, or osteoporosis, is the main cause of vertebral compression fractures. Pathologic fractures related to spinal tumors may also be a cause. To treat these fractures, your doctor can perform a procedure called vertebroplasty or kyphoplasty. Following the procedure, most patients have dramatic improvement in pain and mobility.
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What is Vertebroplasty & Kyphoplasty?
Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of painful vertebral compression fractures (VCF), which are fractures involving the vertebral bodies that make up the spinal column.
In vertebral compression fractures (VCF), the body collapses and compresses into itself, producing a “wedged” vertebra. These compression fractures may involve the collapse of one or more vertebrae in the spine, typically due to osteoporosis or cancer that weakens the bones.
In vertebroplasty, physicians use image guidance, typically fluoroscopy, to inject a cement mixture into the fractured bone through a hollow needle. During kyphoplasty, 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.
Who is a candidate for kyphoplasty/vertebroplasty procedures?
Kyphoplasty and vertebroplasty procedures are generally reserved for people with severe back pain caused by vertebral compression fractures. Candidates for these procedures often have a reduced ability to move and function because of the fractures.
To be a candidate for a kyphoplasty/vertebroplasty, your pain must be caused specifically by the vertebral fracture(s), and not any other issues, such as disk herniation, arthritis, or spinal stenosis (narrowing of the spaces in the spine). Imaging tests — such as spinal x-rays, bone scans, CT or MRI scans — may be used to confirm the presence of a vertebral fracture. If you have osteoporosis, your doctor may also order a dual-energy x-ray absorptiometry (DXA) scan.
Vertebroplasty and kyphoplasty are typically recommended only after less invasive treatments, such as rest, a back brace, or pain medication, have proven ineffective. However, the procedures can be performed immediately in patients with problematic pain requiring hospitalization or for conditions that limit bed rest and pain medications.
Vertebroplasty and kyphoplasty are also performed on patients who:
- are elderly or frail and will likely have impaired bone healing after a fracture
- have vertebral compression due to a malignant tumor
Vertebroplasty and kyphoplasty should be completed within eight weeks of the acute fracture for the highest probability of successful treatment.
You may not be a candidate if you have:
- Non-painful stable compression fractures
- Bone infection (osteomyelitis)
- Bleeding disorders
- Allergy to medications used during the procedure
- Fracture fragment or tumor in the spinal canal
What does the procedure look like?
During vertebroplasty and kyphoplasty, your doctor will inject the bone with a cement mixture to fuse the fragments, strengthen the vertebra and provide pain relief. In both vertebroplasty and kyphoplasty procedures, your doctor will use x-ray equipment, a hollow needle or tube called a trocar, orthopedic cement, and a cement delivery device. For kyphoplasty, a device called a balloon tamp is also used to make room for the balloon catheter. This procedure may use other equipment, including an intravenous line (IV), ultrasound machine and devices that monitor your heart beat and blood pressure.
When the procedure begins, you will lie on the operative table and be given conscious sedation. Once sedated, you will be positioned on your stomach with your chest and sides supported by pillows. Your skin will be cleansed and prepped on the section of the spine (cervical, thoracic, or lumbar) where the compressed vertebra is located.
A local anesthetic will then be injected in the area where a small, half-inch skin incision will be made over the fractured bone. With the aid of a fluoroscope (a special X-ray), two large diameter needles are inserted into the vertebral body. The fluoroscopy monitor allows the doctor to see exactly where the needles are positioned and how far they are inserted. The needles are advanced through the bone using either a twisting motion or a tapping mallet. The needles are angled to avoid the spinal cord. Depending on the vertebral level, a single needle may be used.
Bone cement is then slowly injected under pressure, filling the deepest area first, then withdrawing the needle slightly to fill top areas. The orthopedic cement includes an ingredient called polymethylmethacrylate (PMMA). Its physical appearance resembles toothpaste, which hardens soon after placement in the body. The pressure and amount of cement injected are closely monitored to avoid leakage into unwanted areas. While complete filling of the vertebral body is ideal, it is not always possible or necessary for pain relief.
In kyphoplasty, after numbing the skin locally, a balloon is 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.
The needles will then be withdrawn before the cement hardens. The small incision will be closed with skin glue or steri-strips.
What happens after the procedure?
After the procedure, your blood pressure, heart rate, and respiration will be monitored, and your pain will be addressed. You’ll remain lying down for the first hour after the procedure. You will need someone to drive you home after the procedure. You can return to normal activities, but try to avoid strenuous activities like heavy lifting for at least six weeks.
You might feel pain relief right away, or it might take a few days. Pain caused by the procedure itself should be gone within two to three days.
What are the risks?
Kyphoplasty/vertebroplasty is generally very low-risk. There’s a slight chance you could get an infection, bleeding, increased back pain, numbness and tingling, allergic reactions,, or cement leaking out of position. If you have osteoporosis, there is a risk of developing additional fractures at other vertebral bodies in your spine. To avoid this risk, your healthcare provider will want to ensure that you are on medications to improve your bone density.
At The PainSmith, we provide customized and compassionate pain management care. We offer a variety of diagnostic procedures designed to pinpoint the source of your back pain. During a one-on-one consultation, your doctor will evaluate your symptoms, lifestyle and medical history to identify the problem and develop an effective treatment plan that best meets your needs and goals, which may include vertebroplasty or kyphoplasty.
For more information on back pain treatment in San Antonio, give us a call today at (210) 963-7493. If you would like to request an appointment online, you can do so through our convenient online appointment request form.