All About Vertebroplasty and Kyphoplasty – Preparation, Treatment, & Recovery
- June 10, 2020
- Posted by: Dr. Sumeet Pawar
- Category: Neurosurgery
This article will discuss about osteoporosis, vertebroplasty, balloon kyphoplasty, osteoporotic fracture, compression fracture The spinal column, being subjected to continual pressure and movement, is always prone to wear and fractures. Both systemic or external factors can cause these fractures. And ‘compression fractures’ are one such common vertebral condition that is often caused in a person who has osteoporosis or cancer spreading to bone or anyone who suffers from high-impact spinal trauma. In vertebral compression fractures, a vertebra becomes too weak to bear the normal compressive pressure exerted on the spine and develops tiny cracks on the outer surface, distorting into a wedged shape.
What is osteoporosis? Osteoporosis is a condition in which there is a decrease in bone density. Simply put, the bone is less dense and thereby becomes more brittle. This significantly increases the chance of developing a pathological fracture ie a fracture which develops with a trivial trauma or sometimes even spontaneously. Typically, weight bearing bones such as neck of femur (part of hip joint) or spine are more prone to such fractures.
Why does it occur and how to prevent it? Usually advanced age, females, smokers, heavy drinkers, certain medical conditions such as hyperthyroidism, medicine intake for epilepsy, and of course Vit D3 and calcium deficiency predispose a person to develop osteoporotic compression fractures. So as you can see, some are non-modifiable causes such advanced age, female sex, medical conditions whereas others are modifiable such as smoking, drinking, lack of proper diet. To prevent osteoporosis, it is essential to follow few advices. This holds true for a menopausal female who is more likely to develop an osteoporotic fracture:
- Smoking and drinking cessation
- Improving diet to include more calcium
- Exposure to sunlight as natural source of Vit D3
- Weight bearing exercises to improve bone density such as walking, running, weight lifting etc. The goal of treatment of osteoporosis is to prevent a fracture and if you have already developed fracture
- To prevent a second fracture.
Osteoporosis can cause decrease in bone density and lead to the shell to crack and the bone to collapse. This causes the cube shaped bone to collapse into a wedge shaped bone. It can cause severe pain, muscle spasms, compression of spinal cord and weakness in legs or imbalance of entire spine with a cascading effect on the column.
It needs to be corrected medically and if needed, by filling cement in the bone by a procedure called vertebroplasty.
What is Vertebroplasty and Kyphoplasty? Vertebroplasty is a minimally invasive (MIS) treatment for fortifying fractured vertebrae using bone cement. This technique uses a thin needle to transfer the bone cement into the vertebral cracks without damaging the surrounding soft tissues. This cement stabilizes the vertebra and eliminates the prime cause of back pain in such patients. Several studies have shown that vertebroplasty is more effective in treating compression fracture related back pain and functionality problems than non-surgical treatments. Now-a-days, a more advanced procedure called kyphoplasty is done in which a balloon is first inflated to create space within the bone and then cement is filled. It is proven to have a higher safety profile than vertebroplasty.
When is vertebroplasty recommended?Technically, a vertebral compression fracture is considered valid only if the vertebra losses more than 15% of its height due to the cracks. And vertebroplasty is a specialized treatment for strengthening such vertebra. It is recommended to patients who:
- Have been experiencing persistent back pain for over two weeks which does not improve with non-surgical treatments
- Are experiencing intense pain due to axial load which is caused while getting out of bed or lifting a heavy item
- Are NOT experiencing any neurological problems such as tingling, numbness or poor coordination align with their back pain
- Have a fresh vertebral fracture which has NOT healed significantly
How is Vertebroplasty/ kyphoplasty Performed? The goal of vertebroplasty/ kyphoplasty is to stabilize the fractured vertebrae and restore its strength while eliminating the pain caused due to its restricted movements.And since it is a minimally invasive technique that does not involve any large incisions, it usually takes only about an hour to complete.The patient is made to lie face down, and the back region over the fractured vertebra is sedated with local anesthesia. There is no need for general anesthesia, so patient is awake throughout the procedure. Of course, if patient is too anxious, it can be done under GA also. A contrast-enhanced fluoroscopy device is used to view X-ray video feed of the fractured vertebra on a monitor. This live feed is vital for positioning the needle precisely into the cracks.A necessary amount of an aqueous solution of Polymethyl methacrylate (PMMA) or commonly known as ‘bone cement’ will be filled in injection, and it will be injected into the cracks of the fractured vertebra without touching adjacent structures such as the spinal cord. In kyphoplasty, there is an additional step of inflating a balloon before injecting the cement. The balloon are Korean or American made. Once all the cracks are filled with enough cement, and cement solidifies, the injection is removed, and the puncture is covered with a bandage.The patient is kept under observation for at least two hours to ensure the cement has hardened completely, and no complications were caused in the process.
How To Prepare For A Vertebroplasty? You’ll be asked to not eat or drink anything for 4 – 6 hours before the surgery date. Blood-thinning medications will not be allowed for 5-7 days before the surgery. You’ll also have to discuss your ongoing medication courses with the surgeon to ensure none of them will hamper the surgery’s effects. Your surgeon will also help you find alternative medicines for the time being. It would be prudent to ask a friend or a family member to drive you to and fro the hospital as you won’t be allowed to strain your back after the surgery.
How is the Recovery Process After Vertebroplasty? Bed rest and not performing any back-straining movements is recommended for the first 24 hours. Some soreness and pain can be felt at the puncture site, which will naturally subside in a few days. You’ll be allowed to start your routine activities and medications gradually over the next few days. Strenuous activities such as sports or heavy workout will only be allowed after a period of 6 weeks. You’ll have to attend the follow-up appointments after every one or two weeks to discuss the condition of your spine and what routine activities can be performed.
Are There Any Risks Or Complications Associated With Vertebroplasty? Vertebroplasty, just like any other surgery, carries some rare risks with it. However, since it is performed on one of the more crucial organs of the body, the risks can range for mild to significantly severe conditions such as:
- Spinal infection
- Allergic reaction to the cement or anesthetic
- Excessive bleeding from the puncture site
- Weakness or paralysis in the limbs caused by any damage to the spinal nerves
- Cement leaking out onto adjacent bones or nerves causing pain, tingling or numbness