Kyphoplasty

Kyphoplasty is a minimally invasive spinal surgery procedure used to treat painful, progressive vertebral compression fractures (VCFs). A VCF is a fracture in the body of a vertebra, which causes it to collapse. In turn, this causes the spinal column above it to develop an abnormal forward curve. VCFs may be caused by osteoporosis (an age-related softening of the bones) or by the spread of tumor to the vertebral body. Certain forms of cancer can also weaken bone and cause the same problems.

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 or kyphosis that results from causes other than osteoporosis
• Patients who suffer from spinal stenosis or a herniated disk with nerve or spinal cord compression and loss of neurologic function not associated with a VCF

Technique

Kyphoplasty involves the use of a device called a balloon tamp to restore the height and shape of the vertebral body. This is followed by application of bone cement to strengthen the vertebra. The procedure 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.

To begin, the surgeon makes two small (less than 3 mm) incisions in the back. A tube is inserted into the center of the vertebral body to the site of the fractured bone. The balloon tamp is then inserted down the tube and inflated. This pushes the bone back to its normal height and shape.

Inflation of the balloon creates a cavity in the vertebral body, which the surgeon fills with bone cement. When the cement hardens, the tubes are removed. The incisions are closed with a single stitch, and patients usually go home the same day. Patients can go back to all normal activities of daily living as soon as possible with no restrictions.

It is recommended that kyphoplasty be performed soon after a VCF happens to best restore vertebral body height and size. After kyphoplasty, severe osteoporosis may cause other fractures at other levels of the spine. All patients must take bone-strengthening medications during treatment. If more vertebrae collapse, kyphoplasty can be used at those other levels. Kyphoplasty tends to help prevent additional fractures by keeping the spine aligned in its native upright position.

Outcomes

Early results show kyphoplasty is a safe and effective method to relieve pain and correct the deformity associated with an osteoporotic VCF. More than 95% of patients rate their treatment a success. Patients are able to return to all of their previous activities, and typically do not need any form of physical therapy or rehabilitation. Because bone cement hardens within 15 minutes, there is really no healing that needs to happen from the patient’s standpoint.

Patients occasionally complain of persistent pain after kyphoplasty, but this may be due to irritation of tissues involved in the procedure itself. More than likely, however, persistent pain is due to the underlying arthritis and degeneration of the spine.

Pain resulting from the procedure itself will typically diminish within 2 weeks.

If the pain is due to arthritis in the spine, the usual treatment is medications and an ongoing exercise program.

Complications

Like all surgeries, kyphoplasty does have risks. These risks depend on the patient’s overall health. Complications may require additional treatments, including medications or surgery.

• The usual risks of local or general anesthetics apply.
• There is a small risk of bone cement leaking from within the boundaries of the vertebral body. Most of the time, this rare event (less than 10%) does not cause any problems.
• In rare instances, the cement may irritate or damage the spinal cord or nerves. This can cause pain, altered sensation, or even, very rarely, paralysis (estimated risk is less than 1 in 10,000). Should the cement leak further, more significant surgery may be needed to stop the irritation of the nerves or spinal cord.
• There is also a small chance of the cement traveling to lungs. There is an even smaller chance of the cement block becoming infected at the time of surgery or even years later.