Vertebroplasty and Kyphoplasty

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Vertebroplasty and Kyphoplasty

Definition

The vertebrae are a series of bones that make up the spine. When one fractures , it can put pressure on surrounding nerves. This can cause intense pain and disability. The bones may be repaired with these procedures.

In vertebroplasty, an acrylic cement is injected into a fractured and collapsed vertebra (spinal bone). The cement strengthens the bone and decreases pain from the fracture.
In kyphoplasty, a balloon is used to create a cavity to inject the cement into. This procedure is designed to relieve pain. It can also improve spinal deformities from the fractures.

Reasons for Procedure

Both procedures are used to decrease pain from a vertebral fracture. Kyphoplasty also restores the height of the bone. This can decrease the spinal deformity caused by the fracture.

Other treatment for vertebral fracture may include nonsurgical treatments, such as bed rest, bracing, and pain medicines.

Vertebral Fracture

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a vertebroplasty or kyphoplasty, your doctor will review a list of possible complications which may include:

Leakage of the cement into the spinal canal or into adjacent veins
Infection
Bleeding
Increased back pain
Fracture of adjacent vertebra or ribs
Numbness, tingling
Paralysis

Your doctor may feel that the risks of these procedures are too great if you have:

Vertebral fractures that extend into the spinal canal area
Radiculopathy—irritation of a nerve root in the area of the fracture that often causes areas of numbness, tingling, or weakness in the leg
Current infection
Bleeding disorders
Unusually soft or porous bones

If you have vertebral fracture due to osteoporosis , vertebroplasty may not be as effective.

In addition, smoking can increase the risk of complications.

What to Expect

Prior to Procedure

You will receive a complete physical exam and blood tests.
You will have imaging studies of your back, such as:
- X-ray and Bone scans —tests that use radiation to take pictures of structures inside the body, especially bones
- MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
- CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body
Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
You will need to stop eating at least six hours prior to the procedure. Stop drinking fluids about 3-6 hours prior to the procedure.

Anesthesia

Most are done using only IV sedation and local anesthesia. The sedation will help you relax. The local will numb the area above the fractured bone.
In some cases, general anesthesia may be used. You will be asleep.

Description of Procedure

Vertebroplasty

You will be asked to lie down on your stomach. X-ray cameras will be positioned around you. The cameras will show images of the bone. Your doctor will use this to verify the position of the needles and cement.

The skin over the fractured bone will be numbed and sterilized. A hollow needle will be passed into the vertebra. The acrylic cement will be mixed into a toothpaste-like consistency. An added substance, called barium, will improve the images. When the needle position is ideal, the cement will be injected into the fractured bone. The doctor will watch the cement as it enters the bone to check for leaks.

Kyphoplasty

Your doctor will begin by making a small incision in your back. A tiny drill will be used to create an opening in the bone. A special balloon will be passed through. The balloon will be inflated to open the space and correct the deformity. After the balloon is removed, acrylic cement will be injected into the cavity. This will help to maintain the correction.

Immediately After Procedure

You may have a CT scan to confirm the position of the cement. You will stay on your stomach for about 10-20 minutes. This will allow the cement to harden. You will then be moved to a recovery room. You will be asked to lie on your back for another hour or so.

How Long Will It Take?

40 minutes to 2 hours

How Much Will It Hurt?

You may feel some initial pain due to lying on your stomach. Many notice immediate and significant relief from pain.

Average Hospital Stay

You will usually only need to stay in the hospital for a few hours. You may need to stay longer if you have any complications.

Post-procedure Care

At the Hospital

You will be monitored for a few hours for any complications.

At Home

You may notice some discomfort at the site of the needle insertion or the tiny incision. This is often relieved through the use of an ice pack (use only for 15 minutes per hour). Acetaminophen or nonsteroidal anti-inflammatory medicine may also help. You may also be given medicine to prevent muscle spasm.

You will be asked to stay in bed for about 24 hours after the procedure. After 24 hours, you can gradually increase your activities up to your usual level. Ask your doctor about when it is safe to shower, bathe, or soak in water.

Be sure to follow your doctor’s instructions .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site or the needle insertion site
Severe back or rib pain
Cough, shortness of breath, or chest pain
New numbness, tingling, or weakness

In case of an emergency, call for medical help right away.

RESOURCES

American College of Radiology http://www.acr.org/

American Society of Neuroradiology http://www.asnr.org/

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca/index-eng.php

The Radiological Society of North America http://www.rsna.org/

References

Kyphoplasty. Mayo Clinic website. Available at: http://www.mayoclinic.org/vertebroplasty/kyphoplasty.html . Accessed July 1, 2007.

Predey TA, Sewall LE, Smith SJ. Percutaneous vertebroplasty: New treatment for vertebral compression fractures. American Family Physician . 2002; 66: 611-615.

Vertebroplasty. Mayo Clinic website. Available at: http://www.mayoclinic.org/vertebroplasty/vertebroplasty.html . Accessed July 1, 2007.

Vertebroplasty. RadiologyInfo website. Available at: http://www.radiologyinfo.org/en/info.cfm?pg-vertebro&bhcp=1 . Accessed July 1, 2007.

Vertebroplasty for spine fracture pain. Family Doctor website. Available at: http://familydoctor.org/748.xml . Accessed July 1, 2007.

11/9/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med . 2009;361(6):557-568.

6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

Reviewer: John C. Keel, MD
Review Date: 12/2011 -
Update Date: 12/30/2011 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Cartersville Medical Center