Vertebroplasty and Kyphoplasty
Definition
Vertebroplasty is a procedure in which an acrylic cement is injected into a fractured and collapsed vertebra (spinal bone) in order to strengthen the bone and decrease pain from the fracture.
In kyphoplasty, a balloon is inserted into a fractured and compressed vertebra and inflated, after which acrylic cement is injected into the resulting cavity. Kyphoplasty is designed to relieve pain and improve spinal deformities associated with vertebral compression fractures.
Parts of the Body Involved
Vertebroplasty and kyphoplasty are both procedures that are performed on vertebrae, the individual bones of the spinal column.
Reasons for Procedure
Vertebroplasty is used primarily to decrease the pain associated with a vertebral fracture . Kyphoplasty is used to relieve vertebral fracture pain while also restoring the height of the vertebra and improving spinal deformity caused by vertebral fracture.
Vertebroplasty and kyphoplasty are usually used after more conservative treatments for vertebral fractures (bed rest, bracing, pain medications) have failed to improve the pain of the fracture.
Vertebral Fracture
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Risk Factors for Complications During the Procedure
Your doctor may feel that the risks of these procedures are too great if you have:
- Vertebral fractures that extend into the posterior area of the vertebra, or a vertebral fragment that extends into the spinal canal area.
- Radiculopathy, or irritation of a nerve root in the area of the fracture that often causes areas of numbness, tingling, or weakness in the leg.
- Fever
- Sepsis (bacteria in the bloodstream)
- Bone infection
- Bleeding disorders
- Unusually soft or porous bones
What to Expect
Prior to Procedure
- You’ll receive a complete physical examination, blood tests, and imaging studies of your back (such as x-rays, bone scans, CT scans, and/or MRI scans )
- You’ll usually need to discontinue any blood thinners for several days prior to the procedure
- You’ll need to stop eating at least six hours prior to the procedure, and stop drinking fluids about three to six hours prior to the procedure
The day of your procedure you will:
- Receive an intravenous line
- Be hooked up to monitors to keep track of your heart rate, blood pressure, and oxygen level during the course of the procedure
- Usually receive some intravenous antibiotics to prevent infection
- Receive a sedative medication through the IV
Anesthesia
Most vertebroplasty and kyphoplasty procedures are performed using only intravenous sedation (sent through an IV) and local anesthesia (shots that numb the area around the specific vertebra). In some instances, general anesthesia may be used.
Description of the Procedure
Vertebroplasty
You will be asked to lie down on your stomach on a table in the radiology suite. X-ray cameras (called fluoroscopy cameras) will be positioned on either side of you and above you. These cameras will project real-time images of the involved vertebrae onto a TV-screen monitor in the room, so that your doctor can verify positioning of the needles and cement used in the procedure.
After numbing and sterilizing the skin overlying the fractured vertebra, a hollow needle will be passed into the vertebra. The acrylic cement will be mixed into a toothpaste-like consistency and combined with a substance called barium which will improve the viewing of the procedure via the fluoroscopic cameras. When the needle position is ideal, the cement will be injected into the fractured vertebra. The doctor will watch the cement as it enters the vertebral body to make sure that it doesn’t leak out of the vertebra in a way that could be harmful.
Kyphoplasty
Your doctor will begin the procedure by making a tiny incision in your back, over the area of the compressed vertebra. A tiny drill will be used to create an opening in the bone through which a special balloon can be passed. In order to open the space and correct deformity, the balloon will be positioned within the vertebra and inflated. Then, after the balloon is removed, acrylic cement will be injected in the resulting cavity so as to maintain the correction.
After Procedure
You may undergo a CT scan to verify the positioning of the cement within the vertebra. You’ll stay on your stomach in the radiology suite for about 10-20 minutes to allow the cement to harden. At this point, you can be transferred to a recovery room where you will be asked to lie on your back for another hour or so.
How Long Will It Take?
The entire procedure takes between 40 minutes and two hours.
Will It Hurt?
While you may feel some initial pain in the back due to the position of lying on your stomach, once the acrylic cement has been injected, many patients notice immediate and significant relief from the pain that they have been experiencing from their vertebral fracture.
Possible Complications
- 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
Average Hospital Stay
You will usually only need to stay in the hospital for a few hours on the day of the procedure, unless you have a complication that requires further monitoring, such as
- The need for intravenous anticoagulant medications (ie, blood thinning medication inserted through a vein)
- Fever
- New onset of numbness, tingling, or weakness
- Rib fracture
- Difficulty breathing
Postoperative Care
You may notice some discomfort at the site of the needle insertion or the tiny incision used for kyphoplasty. This is often relieved through the use of an ice pack (use only for 15 minutes per hour), and/or acetaminophen or nonsteroidal anti-inflammatory medications. You may also be given medications to prevent muscle spasm.
You’ll be asked to stay in bed for about 24 hours after the procedure (with the exception of bathroom use). After that 24 hours has passed, you can gradually increase your activities up to your usual level.
RESOURCES:
American College of Radiology
http://www.acr.org/
American Society of Neuroradiology
http://www.asnr.org/
The Radiological Society of North America
http://www.rsna.org/
CANADIAN RESOURCES:
The Radiological Society of North America
http://www.rsna.org
University of Manitoba, Radiology
http://www.umanitoba.ca
References:
Familydoctor. Vertebroplasty for Spine Fracture Pain. Available at: http://familydoctor.org/748.xml . Accessed 7/1/2006.
Mayo Clinic. Kyphoplasty. Available at: http://www.mayoclinic.org/vertebroplasty/kyphoplasty.html . Accessed 7/1/2006.
Mayo Clinic. Vertebroplasty. Available at: http://www.mayoclinic.org/vertebroplasty/vertebroplasty.html . Accessed 7/1/2006.
Predey TA, Sewall LE, Smith SJ. Percutaneous vertebroplasty: New treatment for vertebral compression fractures. American Family Physician . 2002; 66: 611-615.
RadiologyInfo. Vertebroplasty page. Available at: http://www.radiologyinfo.org/en/info.cfm?pg-vertebro&bhcp=1 . Accessed 7/1/2006.
Last reviewed February 2008 by Robert E. Leach, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.
