Vertebroplasty & Kyphoplasty

What is vertebroplasty and kyphoplasty?

Your spine consists of 33 vertebrae, each connected to the other by facet joints and cushioned with intervertebral discs to ease movement. When damage occurs to any part of the spine, the space between the discs can shrink. This causes painful compression of the many nerves that run through the spine.

Vertebroplasty and kyphoplasty are two innovative, minimally-invasive, non-surgical procedures that can strengthen the vertebrae of your spine. These procedures prevent further damage and increase the space between vertebrae.

The two procedures are similar. Vertebroplasty uses bone cement injected between vertebrae to prevent further spinal compression. Kyphoplasty uses a small balloon that is inflated to maintain vertebral spaces.

For many patients who have not found relief from conservative treatments, vertebroplasty and kyphoplasty may help.

How can vertebroplasty or kyphoplasty help me?

Both procedures can reduce pain and increase the height of the vertebrae. Vertebroplasty is also effective at maintaining the proper angle of the spine by keeping the vertebrae properly aligned. Both procedures have been shown to decrease pain and improve vertebral alignment. Patients receiving these procedures not only experience long-term relief, but many also have less pain and more mobility even on the day of the procedure. Some studies have shown that there is a small advantage to kyphoplasty over vertebroplasty when it comes to height restoration, so talk to your doctor if that is a treatment goal.

The syndromes most commonly requiring vertebroplasty and kyphoplasty include:

• Osteoporosis
• Bone cancer metastasis
• Previous trauma or injury

In each of these conditions, the vertebrae can weaken, causing vertebral body fractures.

Patients with compression fractures may also experience kyphosis. Kyphosis, also referred to as a humpback, occurs when the vertebrae collapse. This can be very debilitating and embarrassing for the person who experiences it.

How does vertebroplasty or kyphoplasty work?

Vertebroplasty is an outpatient procedure that involves injecting acrylic cement with a biopsy needle into the fractured vertebra. A local anesthetic and light sedation offer comfort during the procedure. Your doctor guides the needle with X-rays to ensure proper placement. The acrylic cement quickly dries and forms a support structure for stabilization and strength.

Kyphoplasty is also referred to balloon-assisted vertebroplasty. This method involves placing needles into the fractured vertebra and using them to insert a strong, inflatable medical balloon between the vertebra under X-ray guidance. When the balloon is inflated, it creates space in the center of the vertebrae where acrylic cement can be injected using low pressure. The technique works very similarly to vertebroplasty, but the inflation of the balloon may result in an additional increase in the vertebral body height.

Risks

As with all medications and surgical procedures, there is always a risk of complications.

Kyphoplasty and vertebroplasty are considered non-surgical, minimally-invasive treatments for many patients who suffer from back pain, but there are some risks to be aware of. Most of the risks are associated with leaking of acrylic cement outside of the vertebral body or misplacement of the needle.

Side effects due to this may include:

• Infection
• Bleeding
• Numbness
• Tingling
• Headache
• Paralysis

These risks are decreased by the use of X-ray or other radiological imaging to ensure proper placement of the cement.

Recovery

For most patients, recovery from vertebroplasty and kyphoplasty is quick and easy.

After a short rest in recovery, your doctor will encourage you to move around within an hour of the procedure. You may feel some mild soreness, but this is normal and should quickly pass. An ice pack can help relieve this, as can over the counter, non-steroidal anti-inflammatory medications. Since the needle(s) make a small puncture in your skin, it’s easily covered with a small bandage after the procedure.

Rest the day of the procedure, then gradually return to your normal activity levels as you feel stronger. If you experience an increase in pain, swelling or redness at the injection site, or a fever, call your doctor. These may be signs of an infection.

In some case, your recovery may take a bit longer. If your overall health is poor, complications from the procedure arise, or you are receiving injections in more than one vertebrae, you may require an overnight hospital stay.

If your vertebral damage was due to osteoporosis, some lifestyle changes can also help strengthen your bones and decrease the risk of further injury. A balanced diet, regular exercise, weightlifting, calcium, vitamin D supplements, and biosphosphonates (like Fosamax) may help prevent additional compression fractures due to osteoporosis.

References

• Vertebral height restoration in osteoporotic compression fractures: kyphoplasty balloon tamp is superior to postural correction alone. Shindle MK, Gardner MJ, Koob J, Bukata S, Cabin JA, Lane JM. Osteoporosis Int. 2006 Dec;17(12):1815- 9. Epub 2006 Sep 16 PMID: 16983458
• DaFonseca K, Baier M, Grafe I, Libicher M, Noeldge G, Kasperk C, Meeder PJ. Orthopade. 2006 Oct;35(10):1101-9 PMID: 17195295
• Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
• Vertebroplasty for osteoporotic fractures with spinal canal compromise Hiwatashi A, Westesson PL. AJNR Am J Neuroradiol. 2007 Apr;28(4):690-2 PMID: 17416822
• Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. De Negri P, Tirri T, Paternoster G, Modano P. Clin J Pain. 2007 Jun;23(5):425-30 PMID: 17515741
• Vertebral Compression Fractures in the Elderly. Old, Jerry; Calvert, Michelle. American Family Physician. January 1, 2004