Vertebroplasty and Kyphoplasty
Vertebroplasty and Kyphoplasty are minimally invasive procedures used for the treatment of painful vertebral compression fractures.
Vertebral compression fractures are fractures that involve the vertebral or spinal column. When a vertebral is fractured, the bone becomes compressed or changes in shape, causing severe pain.
PA compression fracture may involve the fracture of one or more vertebrae in the spine.
A common condition of a compression fracture is osteoporosis, a condition that leads to loss of bone density, mass, and strength whereby the bone becomes vulnerable and porous.
What is Vertebroplasty?
A vertebroplasty is a procedure whereby a special cement-like mixture known as polymethylmethacrylate is injected into a fractured vertebra through a needle using fluoroscopy as a guide. The aim of this procedure is to restore mobility and relieve spinal pain.
Preparation for the procedure
Before undergoing vertebroplasty, you will first need to be evaluated by your doctor. Your medical history will be reviewed.
You may need to undergo some blood tests and imaging scans.
If you are pregnant, have any medical conditions or allergies, inform your doctor. If you are on any medications, inform your doctor.
You may be advised to stop taking some medications such as aspirin, blood thinners, nonsteroidal anti-inflammatory drugs for several days before the procedure.
You may not be allowed to eat or drink anything for several hours before the procedure.
How is vertebroplasty done?
Before the commencement of the procedure, your blood pressure, heart rate, and pulse may be monitored.
An intravenous line will be inserted into a vein your arm so that sedative medication can be given to you.
You may be moderately sedated or given general anesthesia to make you sleep all through the procedure.
You will be asked to lie down on your stomach facing downwards on an operating bed.
Your doctor will then clean the area where the hollow needle will be inserted.
A local anesthetic will be injected into the skin and deep tissues close to the fractured vertebra.
Your doctor will then make a small incision on the skin and with the aid of x-ray guidance pass a hollow needle through the spinal muscles until the tip of the needle gets to the fractured vertebra.
When the hollow needle is in the right position, a special orthopedic cement is injected into the fractured vertebra through the hollow needle. The cement fills the cracks within the bone to create a type of internal cast that stabilizes the bone.
The needle is removed and the cement quickly hardens up to stabilize the bone. Pressure is then applied to prevent any bleeding and the skin is bandaged up.
This procedure takes about an hour to be completed.
What is Kyphoplasty?
Kyphoplasty is quite similar to vertebroplasty. It involves inserting a special balloon into a fractured bone or vertebrae to create a cavity in the vertebrae. The cavity is then filled with a special orthopedic cement. When the orthopedic cement is hardened, it stabilizes the bone.
The aim of kyphoplasty is to relieve the pain caused by spinal fracture, stabilize the bone and restore the vertebral body height caused by compression fracture.
How is kyphoplasty done?
During a kyphoplasty procedure, you will be asked to lie down on your stomach on a procedure bed.
You will be given general anesthesia to put you asleep all through the procedure.
Your doctor will make a small incision in your back and with the aid of a fluoroscope guidance place a narrow tube. The tube creates a path through your back into the fractured bone in the vertebrae.
With the use of an x-ray, your doctor will insert a special balloon through the tube into the vertebrae. The balloon will be inflated slowly.
As the balloon is being inflated, it raises the fracture and returns the pieces to a more normal position. The balloon also helps to compact the soft inner bone to create a cavity or room inside the vertebrae.
When the balloon is removed, your doctor will then use some special instruments to fill the cavity with an orthopedic cement under low pressure.
The cement hardens up quickly and helps to stabilize the bone.
Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Fractures
Osteoporotic fracture or Osteoporosis is the loss of calcium from bones resulting in weakened bone structure and increased risk of fracture of vertebral body
In osteoporotic fracture, the top of the vertebral body collapses down with more collapse in front thus producing an abnormal vertebral that is described as the “wedged” vertebrae, and the “dowagers” hump, leading to shortened height.
Osteoporotic fracture can lead to chronic or severe pain, limited function and reduced mobility, inability to perform daily activities, decreased lung capacity, and difficulty sleeping.
Vertebroplasty and kyphoplasty are procedures that can be used to resolve osteoporotic fractures and provide pain relief. The two procedures use a special orthopedic cement to fill up cracks within a fractured bone to stabilize the bone.
Frequently asked questions
What is the difference between kyphoplasty and vertebroplasty?
Kyphoplasty and vertebroplasty are both minimally invasive surgical procedures for treating osteoporotic fractures. They are both used to stabilize fractured bone and they provide pain relief in many cases. They both use special orthopedic cement known as polymethylmethacrylate to stabilize fractured bones.
The major difference between kyphoplasty and vertebroplasty is the little difference in their procedures.
Kyphoplasty includes an additional step that involves inserting a special balloon through a tube into the vertebrae. The balloon is slowly inflated to raise the fracture and return the pieces of cracks to a more normal position. The inflated balloon also helps to compact the soft inner bone to create a cavity in the fractured vertebrae where the special cement will be filled.
In vertebroplasty, a hollow needle is passed through the spinal muscles until the tip of the needle gets to the fractured vertebrae. When the hollow needle is in the right position, the special orthopedic cement is injected into the fractured vertebrae through the hollow needle.
Why is kyphoplasty performed?
The goals of kyphoplasty are to stop the pain caused by a spinal fracture, to stabilize the fractured bone, and to restore the lost vertebral height due to the compression fracture.
Is kyphoplasty better than vertebroplasty?
Kyphoplasty is more superior for improving both pain and patient function when compared to vertebroplasty.
In vertebroplasty, the special cement is placed directly into the fractured vertebrae to attempt to stabilize the bone. There is no manipulation of the vertebra from within. The cement injected simply moves between the fracture fragments and binds them together in the position that they are in.
However, kyphoplasty tends to provide better results because the balloon inserted is used to try as much as possible to increase collapse bones. The balloon is inflated to raise the fractured bones and return the pieces of cracks to a more normal position before the cement is delivered.
Kyphoplasty is best when there is severe collapse of the broken vertebra. By first correcting the broken bones, kyphoplasty may help restore the spine to a more normal position and prevent severe “hunchback” deformity to the spine.
How long does vertebroplasty cement last?
Vertebroplasty is considered to be effective for reducing pain and inability to perform daily activities caused by compression fracture on both a short and long-term basis. Vertebroplasty can last for months to years.
What is the success rate of vertebroplasty?
The success rate of vertebroplasty is 73 to 90 percent. Your doctor may only consider vertebroplasty if other treatment options with less risk of complications including bed rest, pain medication, back braces, and physical therapy have failed. Vertebroplasty is most likely to be successful when you undergo it within eight weeks after a vertebral compression fracture.
How long will vertebroplasty last?
Following a vertebroplasty procedure, some patients experience pain relief within 24-48 hours. Results from vertebroplasty can last for months to years.
Who is a candidate for vertebroplasty?
Doctors may only consider vertebroplasty if other treatment options with less risk of complications including bed rest, pain medication, back braces, and physical therapy have failed.
Candidates for vertebroplasty typically have a vertebral compression fracture that is caused by conditions such as osteoporosis, cancer, radiation treatment for cancer or chemotherapy, hyperthyroidism, and long-term use of corticosteroids.
