Kyphoplasty

Background

There are an estimated 1.5 million vertebral compression fractures that occur every year in the United States. Kyphoplasty has been approved by the FDA for treatment of vertebral compression fractures since 1998. It was a progression on the procedure that had traditionally been used to manage vertebral compression fractures since 1987, vertebroplasty. There are an estimated 100,000 cases of vertebral augmentation (both kyphoplasty and vertebroplasty) performed in the United States each year.


What is a Kyhpoplasty?

Kyphoplasty is a minimally invasive procedure that is performed through a small skin puncture utilizing X ray guidance to treat a vertebral compression fracture. The procedure typically takes 60 to 90 minutes to complete. The goals of the procedure include restoring height to the vertebral body, stabilizing the fractured vertebra, and reducing back pain associated with the fracture.


The procedure is performed in a special fluoroscopy suite. An IV is placed beforehand for administration of antibiotics and sedation medications. The patient lays face down on a padded table and the back is thoroughly cleaned. Local anesthesia is used to provide patient comfort throughout the procedure. A small incision is made in the back (less than 1 cm) through which a needle will be placed. The needle is advanced through the soft tissue and eventually into bone. Once bone is encountered, the patient may experience a tapping sensation which is the advancement of the needle through the pedicle and into the vertebral body. A special balloon is then inserted through the needle and into the vertebral body. That balloon is slowly inflated in an attempt to restore as much height to the vertebra as possible and in turn creating a cavity in the bone. The balloon is then deflated and removed. An injection device is then inserted to deliver a cement-like material called polymethylmethacrylate (PMMA). Once the vertebral body has sufficiently been filled with PMMA, the needles are removed and the patient is kept on the table to allow the PMMA to harden within the bone.


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What Medications should I stop before my Kyphoplasty?

Current medical advice for kyphoplasty, is that blood thinning medications should be stopped to prevent a bleeding complication from the procedure. If you are on medications that thin your blood, such as aspirin, warfarin, heparin, enoxoparin, ticlopidine, clopidogrel, diabigatran, dipyridamole, prasugrel, or any other blood thinning agents such as anti-inflammatory agents, please let your physician know and we will instruct you on how far in advance the medication should be stopped. We would also like you to stop NSAID medications in advance of the procedure (ibuprofen, naproxen, Advil, Aleve, diclofenac, meloxicam, etc.). You may continue tylenol. You should continue to take your routine medications (such as high blood pressure and diabetes medications) before the procedure. If you are on antibiotics please notify your physician, we will likely wait to perform your procedure until they are completed. If you have an active infection or fever we will not do the procedure.

When receiving IV sedation you should not eat or drink anything (except your routine medications) for four hours prior to the procedure; this again, lowers the chance of having complications. You are expected to have a ride to and from the procedure.

What are the risks of a Kyphoplasty?

With any operation or injection procedure there are risks. In the case of kyphoplasty, the overall risk of kyphoplasty-related complications are estimated to be less than 4%..


As with any injection through the skin, it is possible for bacteria to gain entry causing an infection. The risk of this with kyphoplasty is very small.


There is also the risk of a bleeding event. If blood were to accumulate close to the spinal cord, this could result in an epidural hematoma that could potentially lead to paralysis. This risk is mitigated by stopping any medications that thin your blood in advance of the procedure as noted above.


There is the possibility of bone cement leakage. Sometimes, the injected bone cement may migrate into an unintended area though in most cases, this does not cause significant complication. If the cement were to migrate into the spinal canal, it could potentially cause paralysis. If it were to migrate close to a nerve root, it could cause injury to that nerve with associated pain and weakness. If bone cement were to enter into a blood vessel, it could potentially cause a clot in the lungs, called a pulmonary embolism. The chances of serious complications are very low as live X rays are taken frequently to monitor how the cement is flowing throughout the vertebral body.


It is possible though extremely rare to have an allergic reaction to bone cement or other agents used during the procedure.


It is possible to have persistent pain after kyphoplasty and there may be facture regarding the shape of the fracture, the degree of height loss, and how long the fracture has been present that could influence the chances of having persistent pain after the procedure.


What should I do after my Kyphoplasty?

Relief of the back pain associated with kyphoplasty can be immediate for some patients though typically there will be some post procedural pain for a few days following. Usual pain medications can be resumed the following day. Patients should rest on the day of their kyphoplasty but may return to normal daily activities the following day. Strenuous activity, lifting and bending should be very limited until you follow up with your physician two weeks after the procedure. You may wear your brace for comfort following the procedure but do not need to adhere to the strict protocol of wearing the brace whenever out of bed following the procedure.

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