Vertebroplasty and kyphoplasty are similar procedures. Both are performed through a hollow needle that is passed through the skin of your back into the fractured vertebra. In vertebroplasty, bone cement (called polymethylmethacrylate) is injected through the hollow needle into the fractured bone. In kyphoplasty, a balloon is first inserted and inflated to expand the compressed vertebra to its normal height before filling the space with bone cement. The procedures are repeated for each affected vertebra. The cement-strengthened vertebra allows you to stand straight, reduces your pain, and prevents further fractures.
Without treatment, the fractures will eventually heal, but in a collapsed position. The benefit of kyphoplasty is that your vertebra is returned to normal position before the bone hardens. Patients who've had kyphoplasty report significantly less pain after treatment [1].
Studies show that people who get one osteoporotic fracture are 5 times more likely to develop additional fractures. It is important that people seek treatment for osteoporosis early, before fractures occur.
Vertebroplasty or kyphoplasty may be a treatment option if you have painful vertebral compression fractures from:
- Osteoporosis (a depletion of calcium in bones)
- Metastatic tumor (cancer spread from another area)
- Multiple myeloma (cancer of the bone marrow)
- Vertebral hemangioma (benign vascular tumor)
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
Vertebroplasty and kyphoplasty will not improve old and chronic fractures, nor will they reduce back pain associated with poor posture and stooping forward. Traditional treatment used to involve waiting 4 to 6 weeks to see if patients improved on their own, but now it's believed that waiting allows the bone to harden, making vertebroplasty or kyphoplasty less effective. Many doctors are now suggesting vertebroplasty as soon as the first week after a fracture for some patients because the results are significantly better [2].
The surgical decision
The surgeon will perform a complete medical history and physical exam. Diagnostic studies (MRI, CT, bone scan) may be included in your evaluation to make a diagnosis of vertebral compression fracture. Your surgeon will also determine if your spine is "stable" or "unstable" and will discuss with you all treatment options.
What happens before surgery?
You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. In the doctors office you will fill out paperwork and sign consent forms so that your surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries, etc.). You should stop taking all non-steroidal anti-inflammatory medicines (Naproxin, Advil, Motrin, Nuprin, etc.) and aspirin one week before your surgery.
Patients are admitted to the hospital the morning of the procedure. No food or drink is permitted past midnight the night before surgery. An intravenous (IV) line is placed in your arm. To minimize pain and discomfort, you will be given either general anesthesia, which puts you to sleep, or conscious sedation. Under conscious sedation you are awake, but feel no pain and may have no memory of the procedure.
Depending on the vertebral level, a single needle may be used. The surgeon may elect to insert the needle slightly above the pedicle if the diameter of the pedicle is too small.
What happens during surgery?
There are five steps to the procedure, which generally takes 1 hour for each vertebra treated.
Step 1: prepare the patient
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. Depending on the section of the spine (cervical, thoracic, or lumbar) where the compressed vertebra is located, your back or neck will be cleansed and prepped.
Step 2: insert the needle
A local anesthetic is 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 machine), two large diameter needles are inserted into the vertebral body through the pedicles (Fig 2). The fluoroscopy monitor allows the surgeon 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.