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Kyphoplasty
Kyphoplasty is a minimally invasive spinal surgery procedure used to treat painful
progressive vertebral body collapse/fracture (VCFs) due to osteoporosis or tumor spread to
the vertebral body.
Osteoporosis, or the age related softening of bones, causes the building blocks of the spine
to weaken and collapse. This results in severe pain and a progressive hunchback. Certain
forms of cancer also weaken the bone and cause the same problems.
Kyphoplasty is not appropriate for patients with young healthy bone or who have been
involved in a major accident and sustained a vertebral body fracture or collapse. Nor is it
appropriate for patients with spinal curvature such as scoliosis or kyphosis that is due to
causes other than osteoporosis. Likewise kyphoplasty is not appropriate for patients who
suffer from spinal stenosis or herniated discs with nerve or spinal cord compression and loss
of neurological function not associated with a vertebral compression fracture.
The kyphoplasty procedure involves the use of a balloon to restore the vertebral body
height and shape followed by bone cement to strengthen it. The procedure may be
performed under intravenous sedation with local anesthetic or under general anesthetic.
The patient lies face-down on the operating room table. Two x-ray machines are used to
visualize the collapsed bones.
The surgeon makes two small (less than 3mm) incisions and inserts a tube into the center of
the vertebral body. Through this tube balloons are placed in the center of the vertebral
body. The balloons are then inflated to push the bone back towards its normal height and
shape. This also helps create a cavity, which the surgeon will fill with the bone cement.
Once the cavity is created, the surgeon removes the inflatable balloon bone tamp, mixes the
cement and fills the cavity in a slow, controlled fashion. After the cement hardens, the
surgeon removes the tubes and closes the incisions with a single stitch. Patients typically go
home the same day. Patients can resume all normal activities of daily living as soon as
possible with no restrictions.
Early results indicate that kyphoplasty is a safe, effective method of vertebral reconstruction
and stabilization in the treatment of osteoporotic VCFs. As with any surgical procedure,
kyphoplasty does have risks.
These complications may require additional treatments in the form of medications or
surgery.
Kyphoplasty is associated with excellent pain relief due to the vertebral body collapse. Well
over 95 percent of patients rate their treatment a success and are able to return to all their
pre-VCF function. Patients typically do not need any form of physical therapy or
rehabilitation after a kyphoplasty procedure. Because bone cement hardens within 15
minutes there is really no healing from the patient’s standpoint that needs to occur.
Occasionally, patients complain of persistent pain after kyphoplasty. This may be due to
irritation of local tissues during the procedure itself. However, it is more likely due to the
underlying arthritic and degenerative changes in the spine. If the persistent pain is due to
the procedure, it will typically diminish within two weeks. If the pain is due to the arthritic
degenerative changes in the spine, the usual treatment consists of medications and an
ongoing exercise program.
Restoration of vertebral body height and size is best when kyphoplasty is performed soon
after the VCFs occur. After kyphoplasty, some patients may develop other fractures at other
levels due to severe osteoporosis. All patients must be on bone-strengthening medications
during treatment, but if further collapse occurs, kyphoplasty can be used at those other
levels as well. Kyphoplasty does have a tendency to help prevent further fractures by
keeping the spine aligned in its native upright position.
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The usual risks of local or general anesthetics apply and depend on the patient’s
overall health.
There is a small risk of the bone cement leaking from within the boundaries of the
vertebral body. In most cases this rare event (occurrence less than 10%) does not
cause any problems.
In very rare circumstances the cement may irritate or damage the spinal cord or
nerves causing pain, altered sensation, or even, very rarely, paralysis (estimated risk
is less than 1 in 10,000). Should the cement leak further, more significant surgery
may be required to relieve the irritation of the nerves or spinal cord.
There also exists a very small chance of the cement traveling to lungs and an even smaller
chance of the cement block becoming infected at the time of surgery or even years after
surgery.