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.
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 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.
Vertebroplasty and kyphoplasty are used to treat painful vertebral compression fractures in the spine, most often the result of osteoporosis.
Typically, vertebroplasty and kyphoplasty are recommended after less invasive treatments, such as bed rest, a back brace or pain medication, have been ineffective. Vertebroplasty and kyphoplasty 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
· suffer from osteoporosis due to long-term steroid treatment or a metabolic disorder
Vertebroplasty and kyphoplasty should be completed within eight weeks of the acute fracture for the highest probability of successful treatment.
Procedure
Vertebroplasty involves injecting the bone with a cement mixture to fuse the fragments, strengthen the vertebra 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 in an interventional radiology suit.
This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure.
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 skin incision is made 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. This procedure is usually completed within one hour. It may take longer if more than one vertebral body level is being treated.
Benefits
· Vertebroplasty and kyphoplasty can increase a patient's functional abilities and allow return to the previous level of activity without any form of physical therapy or rehabilitation.
· These procedures are usually successful at alleviating the pain caused by a vertebral compression fracture; many patients feel significant relief almost immediately or within a few days. Many patients become symptom-free.
· Following vertebroplasty, about 75 percent of patients regain lost mobility and become more active, which helps combat osteoporosis. After the procedure, patients who had been immobile can get out of bed, and this can help reduce their risk of pneumonia. Increased activity builds more muscle strength, further encouraging mobility.
· Usually, vertebroplasty and kyphoplasty are safe and effective procedures.
· No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.
Risks
· A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem, unless the leakage moves into a potentially dangerous location such as the spinal canal or the blood vessels of the lungs.
· Other possible complications include infection, bleeding, increased back pain and neurological symptoms such as numbness or tingling. Paralysis is extremely rare.
· There is a low risk of allergic reaction to the medications.