Definition and Overview
A kyphoplasty, also known as vertebral augmentation, is a surgical procedure used to treat spinal compression fractures, a condition wherein the spinal bone partially or completely collapses. It is also sometimes called a balloon kyphoplasty, in reference to the manner in which the procedure is performed.
Who Should Undergo and Expected Results
A kyphoplasty can be recommended for patients suffering from spinal compression fractures. This injury is more likely to affect people who have or are at risk of osteoporosis. Due to the thinning of the bones that occur as a result of this condition, the patient also faces a high risk of spinal fractures.
The same risk is present in people who have suffered from previous spinal injuries that caused some broken bones in the spine.
Spinal compression fractures, which can also be caused by an existing medical condition such as cancer, particularly multiple myeloma, may cause the following symptoms:
- Sudden onset of back pain
- Severe back pain that seems to get worse over time
- Pain that gets worse when standing up or walking
- Pain that goes away when the person lies down
- Pain when twisting
- Difficulty bending
- Height reduction
- Hip pain
- Breathing difficulties
Spine deformity, usually a hunchback shape, also known as kyphosis
While such injuries are initially treated using pain medications, physical therapy, and rest and rehabilitation, surgery may be an option if the patient’s pain symptoms are:
- Disabling, or hinders him from performing normal activities
Persistent, usually lasting more than two months ,br> The goals of the procedure are as follows:
To relieve pain
- To stabilise the spinal bone
- To restore the lost vertebral body height caused by the fracture
After undergoing a kyphoplasty, patients with spinal compression fractures will experience a significant reduction in their pain levels leading to an improved quality of life. Although some residual pain may still be experienced, it is usually tolerable and the patient may no longer need pain medications for them. Patients also move with more ease than prior to the surgery.
How Does the Procedure Work
A kyphoplasty is usually performed in a hospital as an in-patient procedure but can also be performed in a clinic as an outpatient procedure. The patient will be under local anaesthesia, which means he is awake but will not feel any pain. Sedation is usually also necessary. However, in some cases, patients are also given general anaesthesia, making them sleep throughout the surgery. The procedure usually lasts for an hour, but may take longer if the fracture is more severe.
The procedure is performed with the patient lying face down on the operating table. It begins with the surgeon cleaning the surgical site and administering the anaesthetics. A needle with a balloon is then inserted all the way into the spinal bone before the balloon is inflated to create space in the surgical area. This effectively lifts up or augments the vertebrae, returning it to its normal position. To maintain this position and prevent recurrent injuries, the surgeon deflates and removes the balloon, then injects cement into the affected area using a special low-pressure instrument. The cement material is called polymethylmethacrylate or PMMA, which hardens almost as soon as it is applied, making the effect of the surgery instantaneous.
As the surgeon performs the procedure, the surgical area is monitored by real-time x-ray images to ensure the surgery is performed in a precise manner.
Following the surgery, the patient should be able to walk and may even be discharged the same day but is typically advised against driving as a precautionary measure. It is best for patients who undergo a vertebral augmentation to stay in bed and get enough rest especially during the first 24 hours. They should also avoid strenuous activities during the entire recovery period, which may take at least six weeks.
It is normal for the patient to experience some pain, especially in the surgical site. Applying ice packs will help provide relief.
Possible Risks and Complications
While a vertebral augmentation surgery is generally safe, all surgery carries some degree of risk, including:
- Allergic reaction to medications and dye substances used in x-rays
One risk unique to a kyphoplasty is the possible leakage of the bone cement used in the procedure. This may cause it to spill into the surrounding area, causing some pain especially if the spine and nerves are affected. This complication will require further treatment.
Other associated risks include:
- Residual back pain
- Numbness, which may indicate nerve damage
Weakness, usually also associated with nerve damage
In most cases of spinal compression, however, its benefits outweigh these risks.
Anselmetti GC, Muto M, Guglielmi G, et al. Percutaneous vertebroplasty or kyphoplasty. Radiol Clin North Am. 2010;48(3):641-9.
Berenson J, Pflugmacher R, Jarzem P, et al; Cancer Patient Fracture Evaluation (CAFE) Investigators. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12(3):225-35