Kyphoplasty

Treatment of spinal compression fractures.

Kyphoplasty is a minimally invasive spinal surgery procedure used to treat painful vertebral compression fractures (VCFs) due to osteoporosis or tumor spread to the vertebral body.

The traditional treatment for fractures within a vertebral body (one of bones of the spine) caused by osteoporosis has included pain reduction medication, bed rest, and bracing.  Kyphoplasty offers immediate pain relief and stabilization of the vertebral body.  It is also effective in treating pathologic compression fractures.

Compression fractures of a vertebral body not only cause pain but also cause the spine to shorten and fall forward.  Many people develop a 'hump back' posture deformity after a compression fracture. 

What is an Vertebral Compression Fracture?  In this type of fracture, the top of the vertebral body collapses down with more collapse in front thus producing the "wedged" vertebrae, the "dowagers" hump and shortened height.

Why Treat a Vertebral Compression Fracture?  The first, and most obvious reason is for pain relief.  The relief or decrease in pain after Kyphoplasty is usually immediate, and occurs in about 90% of patients treated.

Prolonged bed rest, or inactivity, causes loss of muscle mass and strength.

Improvement in pulmonary (breathing) function - one thoracic VCF causes 9% loss in ability to take a deep breath.

Psychological consequences Depression develops in up to 40% of patients with compression fractures, due to chronic pain, changes in body image, deterioration in the ability to perform self-care, and pro-longed bed rest.

Background and history:  The most common cause of compression fractures is osteoporosis.  This is a disease characterized by low bone mass and structural changes causing bones to become fragile and easily broken.  Osteoporosis is often referred to as a "silent disease" since the bone loss occurs without symptoms.  Many people do not realize that they have osteoporosis until a fracture occurs.

Vertebral compression fracture (VCF) is the most common fracture associated with osteoporosis, accounting for more than 700,000 or almost half of the total number.  After the first VCF, the risk of subsequent osteoporotic spine fractures increases by more than five-fold.

The initial treatment for a VCF is conservative, using analgesics, bedrest and possible bracing for pain control.  Most patients will have a gradual decrease in pain with these palliative measures.  However, many patients find the pain intolerable, are unwilling to wait several weeks or months for healing, or are intolerant of the brace.

In 1998, the Food and Drug Administration approved a special balloon, the KyphX Inflatable Bone Tamp, for use in reducing (setting) fragility fractures of the spine.  Kyphoplasty often provides significant pain relief and functional improvement, as well as restoring the height and stability of the vertebral body.

More than 3,000 patients have undergone the new procedure in the United States since the balloon’s approval.  The procedure is currently undergoing studies comparing it to other treatments.  I have performed over 100 Kyphoplasties.

Description of kyphoplasty surgery:  The goals of this surgical procedure are designed to stop the pain caused by the bone fracture, to stabilize the bone, and to restore as much vertebral body height as possible.  due to the compression fracture.

A small incision (3/8 in.) is made in the back through which I place a narrow tube.  Using fluoroscopy (like a video X-ray) to guide it to the correct position, the tube creates a path through the back into the fractured area of the involved vertebrae.

I will insert a special balloon through the tube and into the vertebrae, then gently and carefully inflates it.  As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position.  It also compacts the soft inner bone to create a cavity inside the vertebrae.

The balloon is removed and I will use specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA).  After being injected, the pasty material hardens after a few minutes, stabilizing the bone.

Kyphoplasty is performed at the hospital under local or general anesthesia.  Other logistics for a typical procedure are:

• The procedure is done on both the right and left side of the fractured vertebra.  It takes about 1-2 hour for each level involved
• Patients will be observed closely in the recovery room immediately following the procedure and will usually spend one day in the hospital.
• Patients should not drive until they are given approval by their doctor.  If they are released the day of the surgery, they will need to arrange for transportation home from the hospital

Recovery:  Pain relief will be immediate for some patients.  In others, elimination or reduction of pain is reported within two days.  At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.

Patients should see their primary care physician to begin or review their treatment plan for osteoporosis, including medications to prevent further bone loss.

Candidates for kyphoplasty:  Kyphoplasty cannot correct an established (old) deformity of the spine, but it will likely still relieve the pain of the fracture.  Patients experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures are the best candidates for kyphoplasty.  The procedure is often completed within 8 weeks of when the fracture occurs for the highest probability of restoring height, although I have seen good results in with fractures up to 16 weeks old.  Even if a fracture is a few months old, I have seen good pain relief after kyphoplasty, but restoration of vertebral height.

Risks and complications:  All general surgical risks apply to kyphoplasty, including a reaction to anesthesia and infection.  Other risks that are specific to the procedure include:

• Nerve damage or a spinal cord injury from malpositioned instruments placed in the back
• Nerve injury or spinal cord compression from leaking of the PMMA into veins or around the spinal cord.
• Allergic reaction to the solution used to see the balloon on the x-ray image as it inflates
• Osteoporosis is a chronic, progressive disease.  As stated earlier, patients who have sustained these fractures are at an increased risk for additional fractures due to the loss of bone strength caused by the disease.

Please look at the links below for further explanation and illustration.

Spine-Health.com video

Good Kyphoplasty Site

Cleveland Clinic

Some background

Osteoporosis Foundation of Canada

Good Osteoporosis site

Kyphon Homepage

Osteoporosis and Compression Fracture

Osteoporosis Foundation

NIH Osteoporosis Resource Center

Osteoporosis from North American Spine Society